Provider Demographics
NPI:1982107462
Name:ANNA LIVELY, LMHC
Entity Type:Organization
Organization Name:ANNA LIVELY, LMHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVELY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:813-928-5335
Mailing Address - Street 1:PO BOX 752
Mailing Address - Street 2:
Mailing Address - City:BALM
Mailing Address - State:FL
Mailing Address - Zip Code:33503-0752
Mailing Address - Country:US
Mailing Address - Phone:813-928-5335
Mailing Address - Fax:
Practice Address - Street 1:1210 W DEL WEBB BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-5224
Practice Address - Country:US
Practice Address - Phone:813-928-5335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12213261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)