Provider Demographics
NPI:1396464756
Name:DR. LIVENGOOD PSYCHOLOGY, PSYD, PLLC
Entity type:Organization
Organization Name:DR. LIVENGOOD PSYCHOLOGY, PSYD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVENGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:850-276-6401
Mailing Address - Street 1:1315 W 17TH ST UNIT 15034
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32406-7702
Mailing Address - Country:US
Mailing Address - Phone:850-276-6401
Mailing Address - Fax:850-792-6916
Practice Address - Street 1:1315 W 17TH ST UNIT 15034
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32406-7702
Practice Address - Country:US
Practice Address - Phone:850-276-6401
Practice Address - Fax:850-792-6916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-26
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty