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General NPI Number Information
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NPI Number | 1770185308
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Entity Type | Organization
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Legal Business Name | LIVEWELL BEHAVIORAL HEALTH CORP
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Dates
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Enumeration Date | 11/09/2020
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 200 S HARBOR CITY BLVD
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City | MELBOURNE
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State | FL
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Zip | 32901-1384
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Country | US
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Telephone | 321-259-1662
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Fax |
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Provider Business Mailing Address
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Address Line | 200 S HARBOR CITY BLVD STE 401
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City | MELBOURNE
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State | FL
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Zip | 32901-1389
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Country | US
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Telephone | 321-259-1662
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Fax | 321-779-7729
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | MISS MICHELE RONSISVALLE
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Credential |
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Telephone | 321-259-1662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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