Provider Demographics
NPI:1790509354
Name:LIV WELL BEHAVIORAL
Entity type:Organization
Organization Name:LIV WELL BEHAVIORAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-522-4268
Mailing Address - Street 1:900 E PECOS RD STE 8
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2400
Mailing Address - Country:US
Mailing Address - Phone:602-856-6535
Mailing Address - Fax:
Practice Address - Street 1:8315 E HOLLY ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-2823
Practice Address - Country:US
Practice Address - Phone:602-856-6535
Practice Address - Fax:480-618-4133
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIV WELL BEHAVIORAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-11
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ170926Medicaid
AZBH10366OtherADHS