Provider Demographics
NPI:1295095578
Name:LIVINGSTON-CLARK, LANETTE GAY (MED LPC)
Entity type:Individual
Prefix:
First Name:LANETTE
Middle Name:GAY
Last Name:LIVINGSTON-CLARK
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 SPURWING LOOP APT 202
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-7922
Mailing Address - Country:US
Mailing Address - Phone:208-651-0557
Mailing Address - Fax:
Practice Address - Street 1:1713 E SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-5326
Practice Address - Country:US
Practice Address - Phone:208-651-0557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-3630101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional