Provider Demographics
NPI:1245016211
Name:LIVIN HOLISTIC WELLNESS SPA
Entity type:Organization
Organization Name:LIVIN HOLISTIC WELLNESS SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BALFOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-308-8051
Mailing Address - Street 1:4466 ELVIS PRESLEY BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-7100
Mailing Address - Country:US
Mailing Address - Phone:901-210-0083
Mailing Address - Fax:
Practice Address - Street 1:4466 ELVIS PRESLEY BLVD STE 203
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-7100
Practice Address - Country:US
Practice Address - Phone:901-210-0083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty