Provider Demographics
NPI:1053862060
Name:LIVING WELL CONCEPTS
Entity type:Organization
Organization Name:LIVING WELL CONCEPTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:816-617-6259
Mailing Address - Street 1:2536 N 26TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-1601
Mailing Address - Country:US
Mailing Address - Phone:816-617-6259
Mailing Address - Fax:
Practice Address - Street 1:3801 OAKLAND AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3622
Practice Address - Country:US
Practice Address - Phone:816-617-6259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013030909101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1306270186Medicaid