Basic Information
| Provider Information | |||||||||
| NPI: | 1588784664 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVY | ||||||||
| FirstName: | JOEL | ||||||||
| MiddleName: | KUTNER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5534 HUMMINGBIRD ST | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770964922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135699948 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6315 GULFTON ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770811107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134574372 | ||||||||
| FaxNumber: | 7134570945 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| LastUpdateDate: | 06/17/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | N | Behavioral Health & Social Service Providers | Psychologist | 103G00000X | 23083 | TX | Y | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
ID Information
| ID | Type | State | Issuer | Description | 23083 | 01 | TX | TEXAS PSYCHOLOGIST LIC. | OTHER | 620005535 | 01 | TX | RAILROAD MEDICAREPROVIDER | OTHER |