Organization Active NPI

Live, LLC

  • Clinical Social Worker
  • Albuquerque, NM
National Provider Identifier
1275842254
Registry record updated Dec 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I-05823 Issued in NM
Legal business name
LIVE, LLC
Practice address
4004 Carlisle Blvd NE Ste C6
Albuquerque, NM 87107-4565
Phone
(505) 717-7227
Fax
(505) 404-7897
NPI assigned
Sep 24, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Michael W. Ollom, LISW
Title
Member
Phone
(505) 717-7227

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X I-05823 NM Primary

Addresses

Primary practice location

4004 Carlisle Blvd NE Ste C6
Albuquerque, NM 87107-4565

Mailing address

PO Box 35144
Albuquerque, NM 87176-5144
Phone (505) 717-7227

Other identifiers 1

IdentifierTypeStateIssuer
49626019MedicaidNM

Other names 1

  • Live Counseling & Mediation Other name

National Provider Directory

National Provider Directory

Locations

4004 Carlisle Blvd NE
Ste C1
Albuquerque, NM 87107
Phone (505) 264-2609

4233 Montgomery Blvd NE
Ste 240
Albuquerque, NM 87109
Phone (505) 306-2257

4004 Carlisle Blvd NE
Ste C6
Albuquerque, NM 87107
Phone (505) 717-7227

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1285286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702339200000",
    "number": "1275842254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35144",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871765144",
            "telephone_number": "505-717-7227",
            "fax_number": "505-404-7897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4004 CARLISLE BLVD NE STE C6",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871074565",
            "telephone_number": "505-717-7227",
            "fax_number": "505-404-7897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-24",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A",
        "authorized_official_last_name": "OLLOM",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "505-717-7227",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LISW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NM",
            "license": "I-05823",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "49626019",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Live Counseling & Mediation",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.