Provider Demographics
NPI:1326392267
Name:LIVINGSTON, NICHOLAS JAY
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JAY
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15939 SW LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:CACHE
Mailing Address - State:OK
Mailing Address - Zip Code:73527-3027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15939 SW LEE BLVD
Practice Address - Street 2:
Practice Address - City:CACHE
Practice Address - State:OK
Practice Address - Zip Code:73527-3027
Practice Address - Country:US
Practice Address - Phone:580-699-0295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program