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General NPI Number Information
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NPI Number | 1235602806
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Entity Type | Organization
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Legal Business Name | LIVE TO THRIVE, LLC
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Dates
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Enumeration Date | 01/07/2019
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Last Update Date | 04/29/2019
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Provider Practice Location Address
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Address Line | 1532 STATE ROUTE 43
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City | MOGADORE
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State | OH
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Zip | 44260-8820
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Country | US
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Telephone | 330-701-6926
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Fax |
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Provider Business Mailing Address
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Address Line | 1532 STATE ROUTE 43 UNIT A
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City | MOGADORE
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State | OH
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Zip | 44260-8820
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Country | US
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Telephone | 330-422-8777
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Fax | 330-967-0676
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Authorized Official
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Title or Position | OWNER/MANAGING MEMBER
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Name | WENDY MICHELLE HOGAN
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Credential | MAED, LPCC-S
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Telephone | 330-422-8777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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