Provider Demographics
NPI:1891519450
Name:LIV WELL BEHAVIORAL
Entity type:Organization
Organization Name:LIV WELL BEHAVIORAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-522-4268
Mailing Address - Street 1:21608 S 225TH WAY
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-2855
Mailing Address - Country:US
Mailing Address - Phone:480-522-4268
Mailing Address - Fax:480-618-4133
Practice Address - Street 1:908 N WINTHROP CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-6025
Practice Address - Country:US
Practice Address - Phone:480-856-6535
Practice Address - Fax:480-618-4133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health