Provider Demographics
NPI:1073715751
Name:LIVESAY, ROBERT C (LMF)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:C
Last Name:LIVESAY
Suffix:
Gender:M
Credentials:LMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58990 E 290 RD
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344-7712
Mailing Address - Country:US
Mailing Address - Phone:918-786-8537
Mailing Address - Fax:918-787-4333
Practice Address - Street 1:58990 E 290 RD
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-7712
Practice Address - Country:US
Practice Address - Phone:918-786-8537
Practice Address - Fax:918-787-4333
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK800106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist