Provider Demographics
NPI:1164660726
Name:LEVINSON, KATHRYN L (LLP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
Last Name:LEVINSON
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 DIXIE HWY
Mailing Address - Street 2:SUITE #1000
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-5103
Mailing Address - Country:US
Mailing Address - Phone:248-394-3746
Mailing Address - Fax:
Practice Address - Street 1:7300 DIXIE HWY
Practice Address - Street 2:SUITE #1000
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-5103
Practice Address - Country:US
Practice Address - Phone:248-394-3746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013993103TC0700X
MI6361002861103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical