=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811371040
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LSL PSYCHOLOGICAL SERVICES, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2015
-----------------------------------------------------
Last Update Date | 02/23/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1508 GOVERNMENT ST
-----------------------------------------------------
City | OCEAN SPRINGS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39564-3826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-265-5144
-----------------------------------------------------
Fax | 228-233-3693
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4044 BEACON AVE
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28110-9826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-265-5144
-----------------------------------------------------
Fax | 228-233-3693
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST/OWNER
-----------------------------------------------------
Name | DR. LEAH SHARON LEVENSON
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 228-265-5144
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------