Provider Demographics
NPI:1093581894
Name:LIVINGWATER COUNSELING
Entity Type:Organization
Organization Name:LIVINGWATER COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:KORNKVEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:307-333-3060
Mailing Address - Street 1:5311 S DAVID ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-6339
Mailing Address - Country:US
Mailing Address - Phone:307-333-3060
Mailing Address - Fax:
Practice Address - Street 1:411 S WALSH DR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2306
Practice Address - Country:US
Practice Address - Phone:307-336-3770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health