Provider Demographics
NPI:1710529540
Name:LIVINGSTON, LISA (LLPC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5336 N RAISIN CENTER HWY
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-9580
Mailing Address - Country:US
Mailing Address - Phone:734-637-6703
Mailing Address - Fax:
Practice Address - Street 1:5336 N RAISIN CENTER HWY
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-9580
Practice Address - Country:US
Practice Address - Phone:734-637-6703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017670101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional