Provider Demographics
NPI:1497217731
Name:BETHANY LIVINGSTON LMHC LLC
Entity Type:Organization
Organization Name:BETHANY LIVINGSTON LMHC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:321-210-5562
Mailing Address - Street 1:915 BREAKAWAY TRL
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-3263
Mailing Address - Country:US
Mailing Address - Phone:321-210-5562
Mailing Address - Fax:321-888-4980
Practice Address - Street 1:915 BREAKAWAY TRL
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-3263
Practice Address - Country:US
Practice Address - Phone:321-210-5562
Practice Address - Fax:321-888-4980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty