Provider Demographics
NPI:1598210767
Name:LEVITAN AND ASSOCIATES PSYCHOLOGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:LEVITAN AND ASSOCIATES PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:LEVITAN AND ASSOCIATES PSYCHOLOGICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEKSANDR
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVITAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:602-529-1449
Mailing Address - Street 1:2375 E CAMELBACK RD STE 600
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3493
Mailing Address - Country:US
Mailing Address - Phone:602-387-5313
Mailing Address - Fax:602-387-5001
Practice Address - Street 1:2375 E CAMELBACK RD STE 600
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3493
Practice Address - Country:US
Practice Address - Phone:602-529-1449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4709103T00000X, 103TC0700X, 103TF0200X
363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty