Healthcare Provider Details

I. General information

NPI: 1164148029
Provider Name (Legal Business Name): LIVE PURPOSELY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 CRESCENT PARK DR FL 1
RIVERVIEW FL
33578-3625
US

IV. Provider business mailing address

13194 US HIGHWAY 301 S STE 375
RIVERVIEW FL
33578-7410
US

V. Phone/Fax

Practice location:
  • Phone: 813-937-9310
  • Fax:
Mailing address:
  • Phone: 813-937-9310
  • Fax: 813-937-9317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOANNE C BONAMI
Title or Position: OWNER
Credential: LCSW
Phone: 813-937-9310