Provider Demographics
NPI:1629295027
Name:LEVALLEY, AMBER (EDS)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:LEVALLEY
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:HINTHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDS
Mailing Address - Street 1:405 N BINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERTON
Mailing Address - State:AZ
Mailing Address - Zip Code:85350-6307
Mailing Address - Country:US
Mailing Address - Phone:928-341-6041
Mailing Address - Fax:928-341-6090
Practice Address - Street 1:405 N BINGHAM AVE
Practice Address - Street 2:
Practice Address - City:SOMERTON
Practice Address - State:AZ
Practice Address - Zip Code:85350-6307
Practice Address - Country:US
Practice Address - Phone:928-341-6041
Practice Address - Fax:928-341-6090
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist