Provider Demographics
NPI:1851096788
Name:LEVA, TODD THOMAS
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:THOMAS
Last Name:LEVA
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 1:530 HUIZENGA AVE
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-1423
Mailing Address - Country:US
Mailing Address - Phone:616-283-3291
Mailing Address - Fax:
Practice Address - Street 1:2450 VAN OMMEN DR STE C
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8085
Practice Address - Country:US
Practice Address - Phone:616-283-3291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451016541101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health