Healthcare Provider Details

I. General information

NPI: 1083523187
Provider Name (Legal Business Name): LIVING WELL THERAPY SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 W OGDEN AVE UNIT 2332
NAPERVILLE IL
60567-1214
US

IV. Provider business mailing address

1750 W OGDEN AVE UNIT 2332
NAPERVILLE IL
60567-1214
US

V. Phone/Fax

Practice location:
  • Phone: 858-603-8976
  • Fax:
Mailing address:
  • Phone: 858-603-8976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: AMY DIANE LOGAN
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LMHC, LCPC
Phone: 858-603-8976