Provider Demographics
NPI:1407620552
Name:LEVEL UP BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:LEVEL UP BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:239-220-7745
Mailing Address - Street 1:4127 ZELKOVA CT
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-9052
Mailing Address - Country:US
Mailing Address - Phone:239-220-7745
Mailing Address - Fax:
Practice Address - Street 1:708 GOODLETTE-FRANK RD N STE 344
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5644
Practice Address - Country:US
Practice Address - Phone:239-220-7745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-09
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty