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General NPI Number Information
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NPI Number | 1710725940
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Entity Type | Organization
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Legal Business Name | LIV'D WELLNESS COUNSELING
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Dates
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Enumeration Date | 07/20/2024
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Last Update Date | 07/26/2024
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Provider Practice Location Address
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Address Line | 620 EUCLID AVE STE 208
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City | LEXINGTON
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State | KY
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Zip | 40502-6429
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Country | US
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Telephone | 859-539-0312
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Fax |
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Provider Business Mailing Address
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Address Line | 4605 HONEYCOMB TRL
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City | LEXINGTON
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State | KY
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Zip | 40509-9046
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Country | US
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Telephone | 859-539-0312
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST AND NEUROFEEDBACK T
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Name | JESSICA SHANNON
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Credential | LCSW
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Telephone | 859-539-0312
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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 |
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License Number State |
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