MEDICARE: LIVING SOUL, 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	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407363203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVING SOUL, LLC

Provider Business Mailing Address
First Line	:	4538 EMERALD VIS APT H352
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-7219
Country	:	US
Telephone Number	:	561-572-6773
Fax Number	:

Provider Business Practice Location Address
First Line	:	3175 S CONGRESS AVE STE 204A
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-2515
Country	:	US
Telephone Number	:	561-572-6773
Fax Number	:

Authorized Official
Title or Position	:	SCHOOL COUNSELOR
Name	:	WIDLINE PIERRE
Credential	:
Telephone Number	:	561-572-6773

Provider Enumeration Date	:	01/03/2018
Last Update Date	:	12/11/2025

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Directions to “LIVING SOUL, LLC ” Practice Location

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