Healthcare Provider Details

I. General information

NPI: 1376251967
Provider Name (Legal Business Name): LEVINE BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2022
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E ERIE ST STE 525-3022
CHICAGO IL
60611-2740
US

IV. Provider business mailing address

15515 W SUNSET BLVD UNIT 117
PACIFIC PALISADES CA
90272-3530
US

V. Phone/Fax

Practice location:
  • Phone: 310-428-0232
  • Fax: 310-388-4678
Mailing address:
  • Phone: 310-428-0232
  • Fax: 310-388-4678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNY LEVINE
Title or Position: OWNER, FOUNDER, MANAGER
Credential: LCPC
Phone: 310-428-0232