Provider Demographics
NPI:1356976823
Name:LIVING PROOF COUNSELING & WELLNESS, LLC
Entity type:Organization
Organization Name:LIVING PROOF COUNSELING & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:GUTIERREZ
Authorized Official - Last Name:TWOMEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:915-257-8182
Mailing Address - Street 1:3 BUTTERFIELD TRAIL BLVD STE 105A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79906-4921
Mailing Address - Country:US
Mailing Address - Phone:915-257-8182
Mailing Address - Fax:
Practice Address - Street 1:3 BUTTERFIELD TRAIL BLVD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79906-4951
Practice Address - Country:US
Practice Address - Phone:915-257-8182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-05
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty