Provider Demographics
NPI:1841363801
Name:LIEVANOS, AUGUSTUS JR (PSYCHOLOGY DOCTORATE)
Entity type:Individual
Prefix:
First Name:AUGUSTUS
Middle Name:
Last Name:LIEVANOS
Suffix:JR
Gender:M
Credentials:PSYCHOLOGY DOCTORATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3419 E CHAPMAN AVE # 318
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-3812
Mailing Address - Country:US
Mailing Address - Phone:714-935-6363
Mailing Address - Fax:714-935-8112
Practice Address - Street 1:3419 E CHAPMAN AVE # 318
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-3812
Practice Address - Country:US
Practice Address - Phone:714-935-6363
Practice Address - Fax:714-935-8112
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY 19059103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical