Provider Demographics
NPI:1295509198
Name:LIV WELL THERAPY LLC
Entity type:Organization
Organization Name:LIV WELL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRASER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCP
Authorized Official - Phone:410-299-6332
Mailing Address - Street 1:13 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-1101
Mailing Address - Country:US
Mailing Address - Phone:410-299-6332
Mailing Address - Fax:
Practice Address - Street 1:9199 REISTERSTOWN RD STE 202B
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4579
Practice Address - Country:US
Practice Address - Phone:410-299-6332
Practice Address - Fax:410-205-7153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty