Healthcare Provider Details

I. General information

NPI: 1285440214
Provider Name (Legal Business Name): LIVE UP COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6820 GARFIELD AVE
RICHFIELD MN
55423-2331
US

IV. Provider business mailing address

6820 GARFIELD AVE
RICHFIELD MN
55423-2331
US

V. Phone/Fax

Practice location:
  • Phone: 952-457-3189
  • Fax:
Mailing address:
  • Phone: 952-457-3189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: CLAIRE VOEKS
Title or Position: DIRECTOR OF MENTAL HEALTH
Credential: LICSW
Phone: 952-457-3189