Provider Demographics
NPI:1962979302
Name:LIVELY, JEANNE RENEE (LPC)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:RENEE
Last Name:LIVELY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:203 FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-7003
Mailing Address - Country:US
Mailing Address - Phone:334-494-0977
Mailing Address - Fax:
Practice Address - Street 1:830 N OUIDA ST
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2704
Practice Address - Country:US
Practice Address - Phone:334-494-0977
Practice Address - Fax:334-475-2760
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
ALLPC04673101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional