Provider Demographics
NPI:1316984792
Name:LIVESAY, VIRGINIA ELLEN (PHD)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:ELLEN
Last Name:LIVESAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626
Mailing Address - Country:US
Mailing Address - Phone:512-864-9570
Mailing Address - Fax:512-864-9570
Practice Address - Street 1:903 FOREST ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626
Practice Address - Country:US
Practice Address - Phone:512-864-9570
Practice Address - Fax:512-864-9570
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31428103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00639PMedicare UPIN