Provider Demographics
NPI:1124291406
Name:T S LIVINGSTON, INC.
Entity type:Organization
Organization Name:T S LIVINGSTON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:S
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-664-2129
Mailing Address - Street 1:359 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-3018
Mailing Address - Country:US
Mailing Address - Phone:630-664-2129
Mailing Address - Fax:
Practice Address - Street 1:359 WILDWOOD DR
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-3018
Practice Address - Country:US
Practice Address - Phone:630-664-2129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILTL36930602P252Y00000X
IL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232316OtherBLUE CROSS BLUE SHIELD
TL36930602POtherEARLY INTERVENTION