MEDICARE: HEALTHFUL LIVING WAY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18124	OTHER	FL	N/A

General Provider Information

NPI Number	:	1023603016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHFUL LIVING WAY LLC

Provider Business Mailing Address
First Line	:	338 DANIELS POINTE DR
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-4347
Country	:	US
Telephone Number	:	407-968-8284
Fax Number	:

Provider Business Practice Location Address
First Line	:	338 DANIELS POINTE DR
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-4347
Country	:	US
Telephone Number	:	407-968-8284
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANDRE MORRIS
Credential	:	LCSW
Telephone Number	:	407-968-8284

Provider Enumeration Date	:	03/02/2021
Last Update Date	:	03/02/2021

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Directions to “HEALTHFUL LIVING WAY LLC ” Practice Location

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