Provider Demographics
NPI:1548205917
Name:LIVING WELL PSYCHOTHERAPY ASSOCIATES INC
Entity type:Organization
Organization Name:LIVING WELL PSYCHOTHERAPY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHER-PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:727-391-9800
Mailing Address - Street 1:13800 PARK BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33776-3439
Mailing Address - Country:US
Mailing Address - Phone:727-391-9800
Mailing Address - Fax:727-391-9882
Practice Address - Street 1:13800 PARK BLVD STE 206
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33776-3439
Practice Address - Country:US
Practice Address - Phone:727-391-9800
Practice Address - Fax:727-391-9882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9616Medicare PIN