Healthcare Provider Details

I. General information

NPI: 1992482368
Provider Name (Legal Business Name): LIVE ABUNDANTLY THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25050 AVENUE KEARNY STE 203
VALENCIA CA
91355-1257
US

IV. Provider business mailing address

3312 ISABEL DR
LOS ANGELES CA
90065-1958
US

V. Phone/Fax

Practice location:
  • Phone: 213-207-6561
  • Fax:
Mailing address:
  • Phone: 860-617-2210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ERIK SHERMAN
Title or Position: FOUNDER, CEO
Credential: LCSW
Phone: 860-617-2210