MEDICARE: LIVINGWELL THERAPY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YP1600X	Pastoral Counselor
3	101YP2500X	Professional Counselor
4	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1982317236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVINGWELL THERAPY LLC

Provider Business Mailing Address
First Line	:	1162 NW OLD MILL DR
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-6005
Country	:	US
Telephone Number	:	386-590-7662
Fax Number	:

Provider Business Practice Location Address
First Line	:	321 SW MAIN BLVD
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-7053
Country	:	US
Telephone Number	:	386-590-7662
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. NATALIE MOORE
Credential	:	LMHC
Telephone Number	:	386-590-7662

Provider Enumeration Date	:	01/02/2023
Last Update Date	:	01/02/2023

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Directions to “LIVINGWELL THERAPY LLC ” Practice Location

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