Healthcare Provider Details

I. General information

NPI: 1134662026
Provider Name (Legal Business Name): LEVINE PSYCHOLOGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2016
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 HORN AVE APT 610
WEST HOLLYWOOD CA
90069-2119
US

IV. Provider business mailing address

1230 HORN AVE APT 610
WEST HOLLYWOOD CA
90069-2119
US

V. Phone/Fax

Practice location:
  • Phone: 310-488-1116
  • Fax:
Mailing address:
  • Phone: 310-488-1116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPSY18691
License Number StateCA

VIII. Authorized Official

Name: DR. JASON L. LEVINE
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 310-488-1116