Provider Demographics
NPI:1972724631
Name:LIVESAY, HARRY DOUGLAS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:DOUGLAS
Last Name:LIVESAY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:205 E UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6814
Mailing Address - Country:US
Mailing Address - Phone:877-800-5722
Mailing Address - Fax:512-257-1763
Practice Address - Street 1:3950 N A W GRIMES BLVD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-3540
Practice Address - Country:US
Practice Address - Phone:877-800-5722
Practice Address - Fax:512-238-9259
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX262981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1999443-02Medicaid
TX8L8452Medicare PIN