MEDICARE: BETHANY LYNNE LIVINGSTON LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH14088	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689035123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY LYNNE LIVINGSTON LMHC

Provider Business Mailing Address
First Line	:	915 BREAKAWAY TRL
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-3263
Country	:	US
Telephone Number	:	321-210-5562
Fax Number	:

Provider Business Practice Location Address
First Line	:	5095 S WASHINGTON AVE STE 102
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-7333
Country	:	US
Telephone Number	:	321-252-8485
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2016
Last Update Date	:	08/28/2019

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