Healthcare Provider Details

I. General information

NPI: 1407977648
Provider Name (Legal Business Name): MIRANDA KAY LIVINGSTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MIRANDA KAY BUFFINGTON

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4077 JEFFERSON AVE
TEXARKANA AR
71854-1509
US

IV. Provider business mailing address

PO BOX 1326
MARSHALL TX
75671-1326
US

V. Phone/Fax

Practice location:
  • Phone: 870-330-9200
  • Fax:
Mailing address:
  • Phone: 903-927-3782
  • Fax: 903-927-1764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA1503045
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP1802018
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: