Provider Demographics
NPI:1255062147
Name:LIVELY BEHAVIORAL SOLUTIONS LLC
Entity type:Organization
Organization Name:LIVELY BEHAVIORAL SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELLA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:661-300-1272
Mailing Address - Street 1:8442 REILLY DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646
Mailing Address - Country:US
Mailing Address - Phone:513-504-9466
Mailing Address - Fax:949-607-2963
Practice Address - Street 1:8442 REILLY DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646
Practice Address - Country:US
Practice Address - Phone:513-504-9466
Practice Address - Fax:949-607-2963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-21
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty