Provider Demographics
NPI:1619467222
Name:LIVING STREAMS COUNSELING LLC
Entity Type:Organization
Organization Name:LIVING STREAMS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:561-704-3207
Mailing Address - Street 1:2290 10TH AVE N STE 404
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-6618
Mailing Address - Country:US
Mailing Address - Phone:561-704-3207
Mailing Address - Fax:561-469-9390
Practice Address - Street 1:2290 10TH AVE N STE 404
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-6618
Practice Address - Country:US
Practice Address - Phone:561-704-3207
Practice Address - Fax:561-469-9390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
FL305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No305S00000XManaged Care OrganizationsPoint of Service