Provider Demographics
NPI:1821878323
Name:LEVY-NORDHOFF, MILES TYLER
Entity Type:Individual
Prefix:MR
First Name:MILES
Middle Name:TYLER
Last Name:LEVY-NORDHOFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 HIGHLAND AVE # 1563
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-2512
Mailing Address - Country:US
Mailing Address - Phone:805-276-7336
Mailing Address - Fax:
Practice Address - Street 1:13200 CROSSROADS PKWY N STE 335
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91746-3485
Practice Address - Country:US
Practice Address - Phone:805-276-7336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT136991106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist