MEDICARE: ERIN SANDE LEVENBERG MFTI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MI0560	NV

General Provider Information

NPI Number	:	1245638907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN SANDE LEVENBERG MFTI

Provider Business Mailing Address
First Line	:	1325 AIRMOTIVE WAY STE 200
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89502-3240
Country	:	US
Telephone Number	:	775-453-4143
Fax Number	:	775-996-5616

Provider Business Practice Location Address
First Line	:	1325 AIRMOTIVE WAY STE 200
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89502-3240
Country	:	US
Telephone Number	:	775-453-4143
Fax Number	:	775-996-5616

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2014
Last Update Date	:	12/11/2014

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