Provider Demographics
NPI:1508401985
Name:LIVE LEVELED FAMILY THERAPY, INC
Entity Type:Organization
Organization Name:LIVE LEVELED FAMILY THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOREL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-229-6100
Mailing Address - Street 1:809 QUARRY RD APT B
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94129-1150
Mailing Address - Country:US
Mailing Address - Phone:831-229-6100
Mailing Address - Fax:
Practice Address - Street 1:809 QUARRY RD APT B
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94129-1150
Practice Address - Country:US
Practice Address - Phone:831-229-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-09
Last Update Date:2019-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service