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General NPI Number Information
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NPI Number | 1821465121
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Entity Type | Organization
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Legal Business Name | LIVE YOUR WELLNESS LLC
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Dates
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Enumeration Date | 08/22/2015
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Last Update Date | 04/19/2021
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Provider Practice Location Address
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Address Line | 3240 S CORONA ST
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City | ENGLEWOOD
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State | CO
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Zip | 80113-2816
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Country | US
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Telephone | 303-622-5698
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 100856
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City | DENVER
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State | CO
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Zip | 80250-0856
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Country | US
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Telephone | 303-622-5698
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Fax | 303-563-2114
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL R DELL
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Credential | LCSW
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Telephone | 303-622-5698
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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 | 00992544
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License Number State | CO
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