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General NPI Number Information
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NPI Number | 1427600576
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Entity Type | Individual
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Provider Name | LEVINA JORDAN PHILBERT MFT-I
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Gender | Female
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Dates
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Enumeration Date | 07/09/2019
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Last Update Date | 12/11/2020
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Provider Practice Location Address
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Address Line | 5880 BOULDER FALLS ST APT 1062
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City | HENDERSON
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State | NV
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Zip | 89011-4956
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Country | US
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Telephone | 571-719-9291
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Fax |
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Provider Business Mailing Address
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Address Line | 5880 BOULDER FALLS ST APT 1062
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City | HENDERSON
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State | NV
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Zip | 89011-4956
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Country | US
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Telephone | 571-719-9291
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1262
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License Number State | NV
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