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General NPI Number Information
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NPI Number | 1134662026
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Entity Type | Organization
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Legal Business Name | LEVINE PSYCHOLOGICAL CENTER
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Dates
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Enumeration Date | 11/23/2016
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Last Update Date | 11/23/2016
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Provider Practice Location Address
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Address Line | 11340 W OLYMPIC BLVD SUITE 305
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City | LOS ANGELES
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State | CA
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Zip | 90064-1608
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Country | US
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Telephone | 310-488-1116
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Fax | 310-975-1354
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Provider Business Mailing Address
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Address Line | 11340 W OLYMPIC BLVD SUITE 305
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City | LOS ANGELES
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State | CA
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Zip | 90064-1608
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Country | US
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Telephone | 310-488-1116
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Fax | 310-975-1354
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Authorized Official
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Title or Position | CEO
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Name | DR. JASON LEVINE
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Credential | PH.D.
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Telephone | 310-488-1116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PSY18691
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License Number State | CA
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