Provider Demographics
NPI:1760945026
Name:LIVE LIFE FOR REAL,LLC
Entity Type:Organization
Organization Name:LIVE LIFE FOR REAL,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:214-794-9084
Mailing Address - Street 1:824 YOSEMITE TRL
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-7514
Mailing Address - Country:US
Mailing Address - Phone:214-794-9098
Mailing Address - Fax:972-692-7100
Practice Address - Street 1:18601 LBJ FWY STE 480
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6435
Practice Address - Country:US
Practice Address - Phone:214-794-9084
Practice Address - Fax:972-692-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)