Provider Demographics
NPI:1700082849
Name:L'ETOILE DE LE NORD, INC.
Entity Type:Organization
Organization Name:L'ETOILE DE LE NORD, INC.
Other - Org Name:JILL M. PLEVELL, PH.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PLEVELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:520-440-1744
Mailing Address - Street 1:7440 N BOGERT PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-1655
Mailing Address - Country:US
Mailing Address - Phone:520-440-1744
Mailing Address - Fax:
Practice Address - Street 1:37 E SPEEDWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-7714
Practice Address - Country:US
Practice Address - Phone:520-440-1744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1957103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty