Provider Demographics
NPI:1083825723
Name:JIM LEVASSEUR GROUP, INC.
Entity Type:Organization
Organization Name:JIM LEVASSEUR GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:LEVASSEUR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:813-980-2094
Mailing Address - Street 1:12909 N 56TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1275
Mailing Address - Country:US
Mailing Address - Phone:813-980-2094
Mailing Address - Fax:
Practice Address - Street 1:12909 N 56TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-1275
Practice Address - Country:US
Practice Address - Phone:813-980-2094
Practice Address - Fax:813-980-2094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 5991103G00000X, 103TB0200X, 103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty