# LIVE WELL COUNSELING SERVICES PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366079097
- **Authorized official:** JACOB K VICKREY (OWNER)
- **Authorized official phone:** (801) 896-8133

## Contact information

- **Practice address:** 11748 S 3600 W STE 3, SOUTH JORDAN, UT 84095-5922
- **Practice address phone:** (801) 896-8133
- **Mailing address:** 11748 S 3600 W STE 3, SOUTH JORDAN, UT 84095-5922
- **Mailing address phone:** (801) 896-8133

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 104100000X | Social Worker | — | NULL | — |
| 104100000X | Social Worker | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 03/24/2020
- **Last updated:** 08/16/2024