MEDICARE: LIVING WELL COUNSELING AND CONSULTING LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1891537668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVING WELL COUNSELING AND CONSULTING LLC

Provider Business Mailing Address
First Line	:	618 SW 3RD ST STE 110
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-1995
Country	:	US
Telephone Number	:	239-940-7025
Fax Number	:

Provider Business Practice Location Address
First Line	:	618 SW 3RD ST STE 110
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-1995
Country	:	US
Telephone Number	:	239-940-7025
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	VICKI LYNNE BONHAM
Credential	:	LMHC
Telephone Number	:	239-940-7025

Provider Enumeration Date	:	06/11/2024
Last Update Date	:	03/11/2026

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