Provider Demographics
NPI:1295497873
Name:LIVING WATERS COUNSELING LLC
Entity type:Organization
Organization Name:LIVING WATERS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LLEWELYN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:801-599-0649
Mailing Address - Street 1:7016 W SAW TIMBER WAY
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-1907
Mailing Address - Country:US
Mailing Address - Phone:801-599-0649
Mailing Address - Fax:
Practice Address - Street 1:5296 S COMMERCE DR STE 206
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5355
Practice Address - Country:US
Practice Address - Phone:801-599-0649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty