Healthcare Provider Details

I. General information

NPI: 1225914021
Provider Name (Legal Business Name): LIVE WELL PSYCHOTHERAPY SERVICES OF SOUTHWEST MISSOURI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 S MAIN ST
WEBB CITY MO
64870-2379
US

IV. Provider business mailing address

1825 N EAST ST
WEBB CITY MO
64870-1183
US

V. Phone/Fax

Practice location:
  • Phone: 417-203-0413
  • Fax:
Mailing address:
  • Phone: 417-203-0413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. MANDY JEAN WITTHUHN
Title or Position: OWNER
Credential:
Phone: 417-203-0413