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General NPI Number Information
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NPI Number | 1497129639
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Entity Type | Organization
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Legal Business Name | THERAPY FOR LIVING, INC
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Dates
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Enumeration Date | 11/28/2015
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Last Update Date | 11/28/2015
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Provider Practice Location Address
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Address Line | 1544 RUSKIN LN
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-1958
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Country | US
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Telephone | 904-405-9469
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Fax | 855-261-3372
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Provider Business Mailing Address
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Address Line | 1544 RUSKIN LN
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-1958
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Country | US
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Telephone | 904-405-9469
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Fax | 855-261-3372
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | LORI BEARD
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Credential | LMHC
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Telephone | 904-405-9469
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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 | MH11799
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License Number State | FL
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