Provider Demographics
NPI:1336201177
Name:LIVINGSTON, SYLVIA FAY (MFT)
Entity Type:Individual
Prefix:MS
First Name:SYLVIA
Middle Name:FAY
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:SYLVIA
Other - Middle Name:FAY
Other - Last Name:LEMNITZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:515 E 1ST ST
Mailing Address - Street 2:STE. D
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3335
Mailing Address - Country:US
Mailing Address - Phone:714-834-1676
Mailing Address - Fax:714-836-8524
Practice Address - Street 1:515 E 1ST ST
Practice Address - Street 2:STE. D
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3335
Practice Address - Country:US
Practice Address - Phone:714-834-1676
Practice Address - Fax:714-836-8524
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 22313106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist