Healthcare Provider Details

I. General information

NPI: 1396027793
Provider Name (Legal Business Name): WILL L LEVIN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 PEARL ST. SUITE B
EUGENE OR
97401
US

IV. Provider business mailing address

1501 PEARL ST. SUITE B
EUGENE OR
97401
US

V. Phone/Fax

Practice location:
  • Phone: 541-342-1980
  • Fax: 541-342-6207
Mailing address:
  • Phone: 541-342-1980
  • Fax: 541-342-6207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0288
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: