Provider Demographics
NPI:1477315489
Name:LIVE YOUR BEST LIFE THERAPY
Entity Type:Organization
Organization Name:LIVE YOUR BEST LIFE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:N
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-255-3135
Mailing Address - Street 1:4343 MACARTHUR BLVD # 1146
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2180 GEORGETOWN DRIVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881
Practice Address - Country:US
Practice Address - Phone:909-278-8855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-25
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty