Provider Demographics
NPI:1669903316
Name:LIVE LIFE COUNSELING CENTER
Entity type:Organization
Organization Name:LIVE LIFE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LA'MORRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNELIUS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:682-472-6607
Mailing Address - Street 1:1608 RIDGE HAVEN DR
Mailing Address - Street 2:#321
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-9058
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1015 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2259
Practice Address - Country:US
Practice Address - Phone:817-405-9503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67960101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty