MEDICARE: MR. LAWRENCE LEVI MFT 47251

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	47251	CA

General Provider Information

NPI Number	:	1063682649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LAWRENCE LEVI MFT 47251

Provider Business Mailing Address
First Line	:	5820 WILSHIRE BLVD STE 203
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4587
Country	:	US
Telephone Number	:	323-930-0600
Fax Number	:

Provider Business Practice Location Address
First Line	:	5820 WILSHIRE BLVD STE 203
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4587
Country	:	US
Telephone Number	:	323-930-0600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2008
Last Update Date	:	09/01/2009

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