Healthcare Provider Details

I. General information

NPI: 1609604131
Provider Name (Legal Business Name): LIVE LIFE UNLIMITED COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 NW 102ND AVE STE 205
DORAL FL
33172-2131
US

IV. Provider business mailing address

2555 NW 102ND AVE STE 205
DORAL FL
33172-2131
US

V. Phone/Fax

Practice location:
  • Phone: 305-489-8065
  • Fax: 786-635-9058
Mailing address:
  • Phone: 305-489-8065
  • Fax: 786-635-9058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LILIANA L URIBE
Title or Position: MBR
Credential:
Phone: 305-397-4031