Provider Demographics
NPI:1417328030
Name:LIVE LIFE WELL COUNSELING
Entity Type:Organization
Organization Name:LIVE LIFE WELL COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:LATU
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-885-8391
Mailing Address - Street 1:1066 W 1550 S
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-5913
Mailing Address - Country:US
Mailing Address - Phone:801-885-8391
Mailing Address - Fax:
Practice Address - Street 1:1220 N MAIN ST
Practice Address - Street 2:STE 3
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-4013
Practice Address - Country:US
Practice Address - Phone:801-885-8391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7114496-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty