Provider Demographics
NPI:1609271204
Name:LIVE WELL COUNSELING
Entity Type:Organization
Organization Name:LIVE WELL COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:ASPASIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALIOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-603-2626
Mailing Address - Street 1:47 S. 6TH AVENUE
Mailing Address - Street 2:SUITE: H2
Mailing Address - City:LAGRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-5635
Mailing Address - Country:US
Mailing Address - Phone:708-639-4030
Mailing Address - Fax:708-639-4030
Practice Address - Street 1:47 6TH AVE
Practice Address - Street 2:SUITE: H2
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2499
Practice Address - Country:US
Practice Address - Phone:708-639-4030
Practice Address - Fax:708-639-4030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490151211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty