Healthcare Provider Details

I. General information

NPI: 1548205917
Provider Name (Legal Business Name): LIVING WELL PSYCHOTHERAPY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 PARK BLVD STE 206
SEMINOLE FL
33776-3439
US

IV. Provider business mailing address

13800 PARK BLVD STE 206
SEMINOLE FL
33776-3439
US

V. Phone/Fax

Practice location:
  • Phone: 727-391-9800
  • Fax: 727-391-9882
Mailing address:
  • Phone: 727-391-9800
  • Fax: 727-391-9882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: JILL FISCHER-PETERS
Title or Position: OWNER
Credential: L.C.S.W.
Phone: 727-391-9800