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General NPI Number Information
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NPI Number | 1275971335
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Entity Type | Individual
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Provider Name | NICOLE THERESE LEVEILLE PHD, PPS
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Gender | Female
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Dates
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Enumeration Date | 06/11/2013
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Last Update Date | 09/17/2021
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Provider Practice Location Address
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Address Line | 511 S ORCHARD AVE
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City | UKIAH
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State | CA
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Zip | 95482-3470
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Country | US
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Telephone | 707-472-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 475 W CHURCH ST
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City | UKIAH
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State | CA
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Zip | 95482-4817
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Country | US
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Telephone | 707-362-6808
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State | CA
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