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General NPI Number Information
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NPI Number | 1609271204
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Entity Type | Organization
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Legal Business Name | LIVE WELL COUNSELING
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Dates
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Enumeration Date | 10/27/2014
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Last Update Date | 10/27/2014
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Provider Practice Location Address
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Address Line | 47 6TH AVE SUITE: H2
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City | LA GRANGE
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State | IL
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Zip | 60525-2499
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Country | US
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Telephone | 708-639-4030
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Fax | 708-639-4030
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Provider Business Mailing Address
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Address Line | 47 S. 6TH AVENUE SUITE: H2
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City | LAGRANGE
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State | IL
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Zip | 60525-5635
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Country | US
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Telephone | 708-639-4030
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Fax | 708-639-4030
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | MS. ASPASIA PALIOS
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Credential | LCSW
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Telephone | 815-603-2626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149015121
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License Number State | IL
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