Provider Demographics
NPI:1659819589
Name:LIVING WELL WM COUNSELING
Entity Type:Organization
Organization Name:LIVING WELL WM COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KESKITALO
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-690-2159
Mailing Address - Street 1:3672 CHICAGO DR STE A
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-2602
Mailing Address - Country:US
Mailing Address - Phone:616-690-2159
Mailing Address - Fax:
Practice Address - Street 1:3672 CHICAGO DR STE A
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-2602
Practice Address - Country:US
Practice Address - Phone:616-690-2159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-11
Last Update Date:2017-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010873901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty