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General NPI Number Information
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NPI Number | 1548205917
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Entity Type | Organization
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Legal Business Name | LIVING WELL PSYCHOTHERAPY ASSOCIATES INC
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 12/17/2012
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Provider Practice Location Address
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Address Line | 13800 PARK BLVD STE 206
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City | SEMINOLE
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State | FL
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Zip | 33776-3439
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Country | US
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Telephone | 727-391-9800
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Fax | 727-391-9882
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Provider Business Mailing Address
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Address Line | 13800 PARK BLVD STE 206
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City | SEMINOLE
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State | FL
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Zip | 33776-3439
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Country | US
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Telephone | 727-391-9800
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Fax | 727-391-9882
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Authorized Official
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Title or Position | OWNER
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Name | JILL FISCHER-PETERS
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Credential | L.C.S.W.
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Telephone | 727-391-9800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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