Healthcare Provider Details

I. General information

NPI: 1093015208
Provider Name (Legal Business Name): LEVI ALFORD HENRY M.A., P.P.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2010
Last Update Date: 10/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 FARNELL ROAD SUITE A
SANTA MARIA CA
93458-4960
US

IV. Provider business mailing address

4775 HIDALGO AVE.
ATASCADERO CA
93422
US

V. Phone/Fax

Practice location:
  • Phone: 805-922-0334
  • Fax:
Mailing address:
  • Phone: 805-458-6852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: