Provider Demographics
NPI:1558992768
Name:LIVINGSTON, BECKI (MS, NCC, LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:BECKI
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:MS, NCC, LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6906 KINGSTON PIKE STE 104
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5704
Mailing Address - Country:US
Mailing Address - Phone:865-309-5868
Mailing Address - Fax:
Practice Address - Street 1:1704 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-2916
Practice Address - Country:US
Practice Address - Phone:865-681-6990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5168101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ061096Medicaid