Provider Demographics
NPI:1629670948
Name:LIVING WELL MENTAL HEALTH
Entity Type:Organization
Organization Name:LIVING WELL MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:STANFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-303-2544
Mailing Address - Street 1:18151 SW 98TH CT
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5509
Mailing Address - Country:US
Mailing Address - Phone:786-303-2544
Mailing Address - Fax:305-448-7033
Practice Address - Street 1:18151 SW 98TH CT
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-5509
Practice Address - Country:US
Practice Address - Phone:786-303-2544
Practice Address - Fax:305-448-7033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health