Provider Demographics
NPI:1588434203
Name:LIVE OAK COUNSELING AND WELLNESS, LLC
Entity type:Organization
Organization Name:LIVE OAK COUNSELING AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:903-650-9848
Mailing Address - Street 1:107 COMMUNITY BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-6186
Mailing Address - Country:US
Mailing Address - Phone:903-650-9848
Mailing Address - Fax:903-698-6474
Practice Address - Street 1:107 COMMUNITY BLVD STE 2
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-6186
Practice Address - Country:US
Practice Address - Phone:903-650-9848
Practice Address - Fax:903-698-6474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty