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General NPI Number Information
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NPI Number | 1396464756
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Entity Type | Organization
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Legal Business Name | DR. LIVENGOOD PSYCHOLOGY, PSYD, PLLC
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Dates
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Enumeration Date | 08/26/2022
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 1315 W 17TH ST UNIT 15034
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City | PANAMA CITY
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State | FL
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Zip | 32406-7702
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Country | US
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Telephone | 850-276-6401
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Fax | 850-792-6916
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Provider Business Mailing Address
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Address Line | 1315 W 17TH ST UNIT 15034
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City | PANAMA CITY
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State | FL
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Zip | 32406-7702
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Country | US
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Telephone | 850-276-6401
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Fax | 850-792-6916
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Authorized Official
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Title or Position | PSYCHOLOGIST/OWNER
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Name | DR. TARA LIVENGOOD
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Credential | PSYD
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Telephone | 850-276-6401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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