MEDICARE: LIVEFUL THERAPY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1659237204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVEFUL THERAPY PLLC

Provider Business Mailing Address
First Line	:	3923 N FRANCISCO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3505
Country	:	US
Telephone Number	:	773-759-3349
Fax Number	:	773-759-3349

Provider Business Practice Location Address
First Line	:	3923 N FRANCISCO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3505
Country	:	US
Telephone Number	:	773-759-3349
Fax Number	:	773-759-3349

Authorized Official
Title or Position	:	OWNER, PSYCHOTHERAPIST
Name	:	SONYA AVENDANO
Credential	:	MA, LCPC
Telephone Number	:	773-759-3349

Provider Enumeration Date	:	12/29/2025
Last Update Date	:	12/29/2025

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