Provider Demographics
NPI:1811132624
Name:LIVING YOUR DESIGN, LLC
Entity type:Organization
Organization Name:LIVING YOUR DESIGN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:MERTEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:414-430-3122
Mailing Address - Street 1:207 N 116TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4017
Mailing Address - Country:US
Mailing Address - Phone:414-430-3122
Mailing Address - Fax:
Practice Address - Street 1:740 PILGRIM PKWY
Practice Address - Street 2:SUITE 206
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2066
Practice Address - Country:US
Practice Address - Phone:414-430-3122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3499-125251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health