Basic Information
| Provider Information | |||||||||
| NPI: | 1225407919 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIVINGSTON | ||||||||
| FirstName: | IAN | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | APCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2165 LARKSPUR LN | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960020600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302267419 | ||||||||
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| Practice Location | |||||||||
| Address1: | 159 BRENTWOOD DR | ||||||||
| Address2: | |||||||||
| City: | GRASS VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959455703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302711140 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2015 | ||||||||
| LastUpdateDate: | 02/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YA0400X | R1202170515 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.