Provider Demographics
NPI:1336621366
Name:LIVESTRONG, PLLC
Entity Type:Organization
Organization Name:LIVESTRONG, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-AS
Authorized Official - Phone:501-585-4445
Mailing Address - Street 1:317 DOGWOOD PLACE DR
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-2839
Mailing Address - Country:US
Mailing Address - Phone:501-722-2819
Mailing Address - Fax:
Practice Address - Street 1:317 DOGWOOD PLACE DR
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-2839
Practice Address - Country:US
Practice Address - Phone:501-722-2819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)