1215033816 NPI number — ELLEN SUE LEVITOV LPC, LMFT

Table of content: ELLEN SUE LEVITOV LPC, LMFT (NPI 1215033816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215033816 NPI number — ELLEN SUE LEVITOV LPC, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVITOV
Provider First Name:
ELLEN
Provider Middle Name:
SUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC, LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215033816
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
932 WILSON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70119-3832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-232-5283
Provider Business Mailing Address Fax Number:
504-484-7118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4902 CANAL ST
Provider Second Line Business Practice Location Address:
SUITE 203C
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70119-5840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-232-5283
Provider Business Practice Location Address Fax Number:
504-484-7118
Provider Enumeration Date:
09/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  319 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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