Provider Demographics
NPI:1831709179
Name:LIVADA, MAX (LPC)
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:
Last Name:LIVADA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 E. BROAD STREET SUITE 301
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215
Mailing Address - Country:US
Mailing Address - Phone:614-674-6076
Mailing Address - Fax:
Practice Address - Street 1:620 E. BROAD ST. SUITE 301
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-2460
Practice Address - Country:US
Practice Address - Phone:614-674-6076
Practice Address - Fax:833-450-0891
Is Sole Proprietor?:No
Enumeration Date:2020-08-02
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHC.2103907101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator