Provider Demographics
NPI:1407977648
Name:LIVINGSTON, MIRANDA KAY (LPC)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:KAY
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:KAY
Other - Last Name:BUFFINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1326
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75671-1326
Mailing Address - Country:US
Mailing Address - Phone:903-927-3782
Mailing Address - Fax:903-927-1764
Practice Address - Street 1:4077 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1509
Practice Address - Country:US
Practice Address - Phone:870-330-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1503045101YM0800X
171M00000X
ARP1802018101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator