Provider Demographics
NPI:1801364153
Name:LIVINGSTON, MICHAELA (LPC, SAC)
Entity type:Individual
Prefix:MRS
First Name:MICHAELA
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:LPC, SAC
Other - Prefix:MS
Other - First Name:MICHAELA
Other - Middle Name:
Other - Last Name:DIEKRAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, SAC
Mailing Address - Street 1:PO BOX 860912
Mailing Address - Street 2:PROVIDER ENROLLMENT - RST
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0912
Mailing Address - Country:US
Mailing Address - Phone:715-838-5222
Mailing Address - Fax:
Practice Address - Street 1:1400 BELLINGER STREET
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-5222
Practice Address - Country:US
Practice Address - Phone:715-838-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
WI7250101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty