MEDICARE: LIVEWELL MENTAL HEALTH PLLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1821695214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVEWELL MENTAL HEALTH PLLC

Provider Business Mailing Address
First Line	:	6934 ROSALINA LANDING LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-2322
Country	:	US
Telephone Number	:	323-445-3391
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 WILCREST DR STE 170
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-3366
Country	:	US
Telephone Number	:	832-271-7168
Fax Number	:	281-768-4591

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	TAIWO ELEMUREN
Credential	:	PMHNP, FNP
Telephone Number	:	323-445-3391

Provider Enumeration Date	:	10/08/2020
Last Update Date	:	11/21/2023

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