Healthcare Provider Details

I. General information

NPI: 1558992768
Provider Name (Legal Business Name): BECKI LIVINGSTON MS, NCC, LPC-MHSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 E BROADWAY AVE
MARYVILLE TN
37804-2916
US

IV. Provider business mailing address

6906 KINGSTON PIKE STE 104
KNOXVILLE TN
37919-5704
US

V. Phone/Fax

Practice location:
  • Phone: 865-681-6990
  • Fax:
Mailing address:
  • Phone: 865-309-5868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5168
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: