Provider Demographics
NPI:1962162180
Name:LIVE FREE THERAPY LLC
Entity type:Organization
Organization Name:LIVE FREE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JM
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-313-6350
Mailing Address - Street 1:10632 LITTLE PATUXENT PKWY STE 309
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-6294
Mailing Address - Country:US
Mailing Address - Phone:443-313-6350
Mailing Address - Fax:443-283-4136
Practice Address - Street 1:10632 LITTLE PATUXENT PKWY STE 309
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-6294
Practice Address - Country:US
Practice Address - Phone:443-313-6350
Practice Address - Fax:443-283-4136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty