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General NPI Number Information
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NPI Number | 1255543336
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Entity Type | Organization
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Legal Business Name | LIVING WELL PROFESSIONAL SERVICES LLC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 114 W. NORTH STREET SUITE 4
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City | OWOSSO
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State | MI
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Zip | 48867
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Country | US
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Telephone | 989-729-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 114 W. NORTH STREET SUITE 4
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City | OWOSSO
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State | MI
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Zip | 48867
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. CRESCENT S NORMAN
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Credential | MA LPC CAC-1
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Telephone | 989-729-0300
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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 | 6401006614
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License Number State | MI
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