Provider Demographics
NPI:1710725940
Name:LIV'D WELLNESS COUNSELING
Entity type:Organization
Organization Name:LIV'D WELLNESS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST AND NEUROFEEDBACK T
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:859-539-0312
Mailing Address - Street 1:4605 HONEYCOMB TRL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-9046
Mailing Address - Country:US
Mailing Address - Phone:859-539-0312
Mailing Address - Fax:
Practice Address - Street 1:620 EUCLID AVE STE 208
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-6429
Practice Address - Country:US
Practice Address - Phone:859-539-0312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-20
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty