Basic Information
| Provider Information | |||||||||
| NPI: | 1235664335 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEVITT | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | DAVID | ||||||||
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| Mailing Information | |||||||||
| Address1: | 784 GARDENIA AVE APT 6 | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908135959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263537611 | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 CORPORATE CENTER DR STE 202 | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917682627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9097667060 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2017 | ||||||||
| LastUpdateDate: | 04/26/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF96899 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.