Provider Demographics
NPI:1669820759
Name:LIVINGSTON-SHELBURNE, ALYSSANDRA (LPC)
Entity Type:Individual
Prefix:
First Name:ALYSSANDRA
Middle Name:
Last Name:LIVINGSTON-SHELBURNE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 PAYTON GIN RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-6506
Mailing Address - Country:US
Mailing Address - Phone:512-836-2150
Mailing Address - Fax:512-836-2159
Practice Address - Street 1:1600 PAYTON GIN RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-6506
Practice Address - Country:US
Practice Address - Phone:512-836-2150
Practice Address - Fax:512-836-2159
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-30
Last Update Date:2016-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72489101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional