Healthcare Provider Details

I. General information

NPI: 1487917191
Provider Name (Legal Business Name): SIMON LIVINGSTONE, M.D. P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 1ST AVE SUITE 720
SEATTLE WA
98121-2158
US

IV. Provider business mailing address

2025 1ST AVE SUITE 720
SEATTLE WA
98121-2158
US

V. Phone/Fax

Practice location:
  • Phone: 206-949-0027
  • Fax: 206-448-6945
Mailing address:
  • Phone: 206-949-0027
  • Fax: 206-448-6945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberMD60236909
License Number StateWA

VIII. Authorized Official

Name: DR. SIMON LIVINGSTONE
Title or Position: MANAGING MEMBER, PSYCHIATRIST
Credential: M.D.
Phone: 206-949-0027