Provider Demographics
NPI:1821465121
Name:LIVE YOUR WELLNESS LLC
Entity Type:Organization
Organization Name:LIVE YOUR WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:DELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:303-622-5698
Mailing Address - Street 1:PO BOX 100856
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80250-0856
Mailing Address - Country:US
Mailing Address - Phone:303-622-5698
Mailing Address - Fax:303-563-2114
Practice Address - Street 1:3240 S CORONA ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2816
Practice Address - Country:US
Practice Address - Phone:303-622-5698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-22
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO009925441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty