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General NPI Number Information
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NPI Number | 1679007603
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Entity Type | Organization
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Legal Business Name | LIVING WELL COUNSELING AND THERAPY SOLUTIONS
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Dates
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Enumeration Date | 04/17/2017
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Last Update Date | 04/17/2017
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Provider Practice Location Address
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Address Line | 302 S KITCHELL AVE SUITE B
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City | OLNEY
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State | IL
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Zip | 62450-1500
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Country | US
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Telephone | 618-354-0878
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Fax |
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Provider Business Mailing Address
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Address Line | 302 S. KITCHELL AVE SUITE B
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City | OLNEY
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State | IL
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Zip | 62450
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Country | US
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Telephone | 618-354-0878
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. SANDY G BURKE
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Credential | MS
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Telephone | 618-354-0878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 180005527
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License Number State | IL
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