Individual
KEITH LIVINGSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
21360 N 1450 E, MORONI, UT 84646-7629
(435) 262-1217
Mailing address
330 W 800 S, MOUNT PLEASANT, UT 84647-1929
(435) 262-9901
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
32253J00000X
UT
175T00000X
Peer Specialist
—
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235458555
—
UT
05
—
1270465727
—
UT
Enumeration date
02/15/2023
Last updated
02/15/2023
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