MEDICARE: DR. CURTIS A. LEVANG PH.D.

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	103TC0700X	Clinical Psychologist	LP1408	MN
2	106H00000X	Marriage & Family Therapist	0235	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	68786LE	OTHER	MN	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427264928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CURTIS A. LEVANG PH.D.

Provider Business Mailing Address
First Line	:	4010 BAYSIDE RD
Second Line	:
City	:	MAPLE PLAIN
State	:	MN
Zip	:	55359-9619
Country	:	US
Telephone Number	:	952-541-4799
Fax Number	:	952-541-4831

Provider Business Practice Location Address
First Line	:	8441 WAYZATA BLVD
Second Line	:	SUITE 102
City	:	GOLDEN VALLEY
State	:	MN
Zip	:	55426-1344
Country	:	US
Telephone Number	:	952-541-4799
Fax Number	:	763-231-4445

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	12/16/2014

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