Healthcare Provider Details

I. General information

NPI: 1790678423
Provider Name (Legal Business Name): MERCEDES NICHOLE LIVENGOOD LIMHP LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 N 200TH AVE
ELKHORN NE
68022-1885
US

IV. Provider business mailing address

3101 N 200TH AVE
ELKHORN NE
68022-1885
US

V. Phone/Fax

Practice location:
  • Phone: 402-619-0113
  • Fax:
Mailing address:
  • Phone: 402-619-0113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4155
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2538
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: