Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1093015208 |
---|---|
Provider Name | Mr. Levi Alford Henry |
First Address | Atascadero, CA 93422 |
Second Address | Santa Maria, CA 93458-4960 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2010 |
Last Update Date | 22/10/2010 |