Provider Demographics
NPI:1811169261
Name:LEVELLE, JAMES ALFRED JR (PHD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ALFRED
Last Name:LEVELLE
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18268 PETROLEUM DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-6126
Mailing Address - Country:US
Mailing Address - Phone:225-975-4262
Mailing Address - Fax:888-345-7986
Practice Address - Street 1:18268 PETROLEUM DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-6126
Practice Address - Country:US
Practice Address - Phone:225-975-4262
Practice Address - Fax:888-345-7986
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA886103T00000X, 103TM1800X, 103TS0200X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1307033Medicaid
LA1032719Medicaid