Provider Demographics
NPI:1649792292
Name:LIVINGSTON PSYCHOLOGICAL SERVICES, PLLC
Entity type:Organization
Organization Name:LIVINGSTON PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMPTON
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:734-377-4580
Mailing Address - Street 1:204 W GRAND RIVER AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-2250
Mailing Address - Country:US
Mailing Address - Phone:517-540-6166
Mailing Address - Fax:517-546-9148
Practice Address - Street 1:204 W GRAND RIVER AVE STE 260
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843
Practice Address - Country:US
Practice Address - Phone:517-540-6166
Practice Address - Fax:517-546-9148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006503103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty