Provider Demographics
NPI:1851523336
Name:LIVINGSTON, CLARISSA ASENATH (LMP)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:ASENATH
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24837 104TH AVE SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-6800
Mailing Address - Country:US
Mailing Address - Phone:253-854-7700
Mailing Address - Fax:253-854-2986
Practice Address - Street 1:24837 104TH AVE SE
Practice Address - Street 2:SUITE 100
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-6800
Practice Address - Country:US
Practice Address - Phone:253-854-7700
Practice Address - Fax:253-854-2986
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60063480225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist