Basic Information
| Provider Information | |||||||||
| NPI: | 1770223950 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVAN | ||||||||
| FirstName: | VALERIA | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | MA, BCBA, LBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7194 TIMBER RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782271741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103792349 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 419 CARSON HL STE 202 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782515500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8557827822 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2022 | ||||||||
| LastUpdateDate: | 03/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 4946 | TX | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.