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General NPI Number Information
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NPI Number | 1255785788
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Entity Type | Organization
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Legal Business Name | LIVE WELL THERAPY ASSOCIATES, LLC
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Dates
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Enumeration Date | 04/21/2016
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Last Update Date | 04/21/2016
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Provider Practice Location Address
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Address Line | 221 WILLIAMS AVE
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City | NARBERTH
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State | PA
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Zip | 19072-2018
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Country | US
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Telephone | 215-480-0173
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Fax |
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Provider Business Mailing Address
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Address Line | 111 FORREST AVE
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City | NARBERTH
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State | PA
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Zip | 19072
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Country | US
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Telephone | 215-480-0173
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | JOHANNA KULP
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Credential | LCSW
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Telephone | 610-888-5031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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