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General NPI Number Information
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NPI Number | 1184032633
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Entity Type | Organization
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Legal Business Name | LIVINGWELL PSYCHOTHERAPY, INC.
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Dates
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Enumeration Date | 07/29/2014
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Last Update Date | 07/29/2014
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Provider Practice Location Address
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Address Line | 8530 FM 1960 RD E STE 110
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City | HUMBLE
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State | TX
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Zip | 77346-1831
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Country | US
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Telephone | 281-731-3108
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Fax | 281-457-1014
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Provider Business Mailing Address
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Address Line | PO BOX 1587
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City | CROSBY
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State | TX
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Zip | 77532-1587
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Country | US
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Telephone | 281-731-3108
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Fax | 281-457-1014
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. TAMARA LEIGH ESTEP
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Credential | LPC
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Telephone | 281-731-3108
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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 | 65682
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License Number State | TX
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