Provider Demographics
NPI:1710739172
Name:LIVINGSTON, NATALIE STARR
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:STARR
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 12TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BUHL
Mailing Address - State:ID
Mailing Address - Zip Code:83316-1507
Mailing Address - Country:US
Mailing Address - Phone:208-212-2500
Mailing Address - Fax:
Practice Address - Street 1:417 12TH AVE N
Practice Address - Street 2:
Practice Address - City:BUHL
Practice Address - State:ID
Practice Address - Zip Code:83316-1507
Practice Address - Country:US
Practice Address - Phone:208-212-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician