Provider Demographics
NPI:1932822319
Name:LIVE FULLY THERAPY PLLC
Entity type:Organization
Organization Name:LIVE FULLY THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCPC AND DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRIENT
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LCPC, RD, LDN
Authorized Official - Phone:228-547-5111
Mailing Address - Street 1:1435 W WRIGHTWOOD AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-0625
Mailing Address - Country:US
Mailing Address - Phone:228-547-5111
Mailing Address - Fax:
Practice Address - Street 1:1435 W WRIGHTWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-0625
Practice Address - Country:US
Practice Address - Phone:312-857-4868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty