Provider Demographics
NPI:1447624077
Name:LIVE MINDFULLY
Entity type:Organization
Organization Name:LIVE MINDFULLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:425-903-8953
Mailing Address - Street 1:12840 SE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-3605
Mailing Address - Country:US
Mailing Address - Phone:801-694-7143
Mailing Address - Fax:
Practice Address - Street 1:12840 SE 3RD ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3605
Practice Address - Country:US
Practice Address - Phone:801-694-7143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty