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General NPI Number Information
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NPI Number | 1669903316
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Entity Type | Organization
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Legal Business Name | LIVE LIFE COUNSELING CENTER
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Dates
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Enumeration Date | 03/24/2017
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Last Update Date | 03/24/2017
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Provider Practice Location Address
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Address Line | 1015 PENNSYLVANIA AVE SUITE 7
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City | FORT WORTH
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State | TX
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Zip | 76104-2259
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Country | US
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Telephone | 817-405-9503
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Fax |
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Provider Business Mailing Address
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Address Line | 1608 RIDGE HAVEN DR #321
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City | ARLINGTON
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State | TX
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Zip | 76011-9058
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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 | OWNER
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Name | LA'MORRA CORNELIUS
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Credential | LPC
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Telephone | 682-472-6607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 67960
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License Number State | TX
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