Provider Demographics
NPI:1053134601
Name:LIV CENTER FOR REPRODUCTIVE HEALING
Entity type:Organization
Organization Name:LIV CENTER FOR REPRODUCTIVE HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:EVONNE
Authorized Official - Last Name:WICKS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LPC-S
Authorized Official - Phone:469-373-3991
Mailing Address - Street 1:5050 QUORUM DR STE 600
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-7024
Mailing Address - Country:US
Mailing Address - Phone:469-373-3991
Mailing Address - Fax:
Practice Address - Street 1:5050 QUORUM DR STE 600
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-7024
Practice Address - Country:US
Practice Address - Phone:469-373-3991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty