Healthcare Provider Details

I. General information

NPI: 1255758736
Provider Name (Legal Business Name): ANNA LIVELY LMHC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 KELSEY WAY
SUN CITY CENTER FL
33573-6135
US

IV. Provider business mailing address

PO BOX 752
BALM FL
33503-0752
US

V. Phone/Fax

Practice location:
  • Phone: 813-928-5335
  • Fax:
Mailing address:
  • Phone: 813-928-5335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH12213
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMH12213
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: