Provider Demographics
NPI:1013755917
Name:LIVE WELL PSYCHOLOGY GROUP, INC
Entity type:Organization
Organization Name:LIVE WELL PSYCHOLOGY GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLOVATYK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:424-453-8089
Mailing Address - Street 1:419 HILL ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-4284
Mailing Address - Country:US
Mailing Address - Phone:330-507-7441
Mailing Address - Fax:
Practice Address - Street 1:11845 W OLYMPIC BLVD STE 1080W
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-5023
Practice Address - Country:US
Practice Address - Phone:424-453-8084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Single Specialty