Provider Demographics
NPI:1669924221
Name:LIVING WELL COUNSELING, PLLC
Entity type:Organization
Organization Name:LIVING WELL COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:GOOCH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:214-444-6135
Mailing Address - Street 1:752 N MAIN ST
Mailing Address - Street 2:1391
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3229
Mailing Address - Country:US
Mailing Address - Phone:214-444-6135
Mailing Address - Fax:
Practice Address - Street 1:8828 N STEMMONS FWY
Practice Address - Street 2:225
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-3719
Practice Address - Country:US
Practice Address - Phone:214-444-6135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70940101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty