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General NPI Number Information
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NPI Number | 1073291043
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Entity Type | Organization
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Legal Business Name | LIVE WELL THERAPY
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Dates
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Enumeration Date | 07/10/2023
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 6607 18TH AVE S STE 101
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City | RICHFIELD
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State | MN
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Zip | 55423-2784
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Country | US
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Telephone | 612-801-3168
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Fax |
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Provider Business Mailing Address
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Address Line | 19022 EMBRY LN
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City | FARMINGTON
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State | MN
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Zip | 55024-9196
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Country | US
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Telephone | 612-801-3168
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | MICHELLE ANN SCHMID-EGLESTON
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Credential | LP
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Telephone | 612-801-3168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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