Provider Demographics
NPI:1457105249
Name:LEVINE THERAPY, LICENSED PROFESSIONAL CLINICAL COUNSELOR, PC
Entity Type:Organization
Organization Name:LEVINE THERAPY, LICENSED PROFESSIONAL CLINICAL COUNSELOR, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:310-428-0232
Mailing Address - Street 1:1601 N SEPULVEDA BLVD # 621
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-5111
Mailing Address - Country:US
Mailing Address - Phone:310-428-0232
Mailing Address - Fax:310-388-4678
Practice Address - Street 1:3012 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2413
Practice Address - Country:US
Practice Address - Phone:310-428-0232
Practice Address - Fax:310-388-4678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty