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General NPI Number Information
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NPI Number | 1043122849
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Entity Type | Organization
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Legal Business Name | LIVEWELL THERAPY, LLC
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Dates
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Enumeration Date | 09/18/2026
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Last Update Date | 09/18/2026
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Provider Practice Location Address
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Address Line | 1222 MAIN ST APT 5
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City | UNION GROVE
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State | WI
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Zip | 53182-1343
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Country | US
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Telephone | 262-232-4290
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Fax |
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Provider Business Mailing Address
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Address Line | 3635 BRITTON RDG
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City | UNION GROVE
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State | WI
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Zip | 53182-9360
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Country | US
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Telephone | 262-939-3936
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Fax |
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Authorized Official
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Title or Position | LPC
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Name | DEREK ALCALA
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Credential |
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Telephone | 262-939-3936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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