Provider Demographics
NPI:1770185308
Name:LIVEWELL BEHAVIORAL HEALTH CORP
Entity type:Organization
Organization Name:LIVEWELL BEHAVIORAL HEALTH CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:RONSISVALLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-259-1662
Mailing Address - Street 1:200 S HARBOR CITY BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1389
Mailing Address - Country:US
Mailing Address - Phone:321-259-1662
Mailing Address - Fax:321-779-7729
Practice Address - Street 1:200 S HARBOR CITY BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1384
Practice Address - Country:US
Practice Address - Phone:321-259-1662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty