Provider Demographics
NPI:1063682649
Name:LEVI, LAWRENCE (MFT 47251)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:
Last Name:LEVI
Suffix:
Gender:M
Credentials:MFT 47251
Other - Prefix:MR
Other - First Name:LARRY
Other - Middle Name:
Other - Last Name:LEVI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT 47251
Mailing Address - Street 1:5820 WILSHIRE BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4587
Mailing Address - Country:US
Mailing Address - Phone:323-930-0600
Mailing Address - Fax:
Practice Address - Street 1:5820 WILSHIRE BLVD STE 203
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4587
Practice Address - Country:US
Practice Address - Phone:323-930-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47251106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist