Provider Demographics
NPI:1649750753
Name:LIVENGOOD, TARA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:
Last Name:LIVENGOOD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 MARLANDWOOD RD STE 114
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-3331
Mailing Address - Country:US
Mailing Address - Phone:254-228-0404
Mailing Address - Fax:254-228-0505
Practice Address - Street 1:1005 MARLANDWOOD RD STE 114
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-3331
Practice Address - Country:US
Practice Address - Phone:254-228-0404
Practice Address - Fax:254-228-0505
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10222103TC0700X
TX39532103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical