Provider Demographics
NPI:1144342874
Name:LIVINGSTON, PENELOPE G (LMFT)
Entity type:Individual
Prefix:MS
First Name:PENELOPE
Middle Name:G
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5228 W MERCER WAY
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-4632
Mailing Address - Country:US
Mailing Address - Phone:206-818-5249
Mailing Address - Fax:425-237-4372
Practice Address - Street 1:5228 W MERCER WAY
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-4632
Practice Address - Country:US
Practice Address - Phone:206-818-5249
Practice Address - Fax:425-237-4372
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist