Healthcare Provider Details

I. General information

NPI: 1194817288
Provider Name (Legal Business Name): CINDY JANE LIVINGSTON LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W SOUTH BOUNDARY ST BLDG 7B
PERRYSBURG OH
43551-5244
US

IV. Provider business mailing address

900 W SOUTH BOUNDARY ST BLDG 7B
PERRYSBURG OH
43551-5244
US

V. Phone/Fax

Practice location:
  • Phone: 419-356-7715
  • Fax: 877-622-7635
Mailing address:
  • Phone: 419-356-7715
  • Fax: 877-622-7635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0009614
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: