Provider Demographics
NPI:1487686879
Name:ACTIVE LIVING LLC
Entity Type:Organization
Organization Name:ACTIVE LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:731-783-1975
Mailing Address - Street 1:PO BOX 444
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:TN
Mailing Address - Zip Code:38355-0444
Mailing Address - Country:US
Mailing Address - Phone:731-783-1975
Mailing Address - Fax:731-723-1148
Practice Address - Street 1:503 W CHURCH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MEDINA
Practice Address - State:TN
Practice Address - Zip Code:38355-8769
Practice Address - Country:US
Practice Address - Phone:731-783-1975
Practice Address - Fax:731-723-1148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty