Provider Demographics
NPI:1699796797
Name:LIVINGSTON, JAY STEWART (MS, LPC, SAC)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:STEWART
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:MS, LPC, SAC
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Other - Middle Name:
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Mailing Address - Street 1:421 NEBRASKA ST
Mailing Address - Street 2:DOOR COUNTY DEPARTMENT OF COMMUNITY PROGRAMS
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-2225
Mailing Address - Country:US
Mailing Address - Phone:920-746-2345
Mailing Address - Fax:920-746-2439
Practice Address - Street 1:421 NEBRASKA ST
Practice Address - Street 2:DOOR COUNTY DEPARTMENT OF COMMUNITY PROGRAMS
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-2225
Practice Address - Country:US
Practice Address - Phone:920-746-2345
Practice Address - Fax:920-746-2439
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2011-05-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI2583101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39731200Medicaid
OTH000Medicare UPIN