Provider Demographics
NPI:1447472154
Name:LEVY, LARS L (BS)
Entity type:Individual
Prefix:
First Name:LARS
Middle Name:L
Last Name:LEVY
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 FIR DR
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1019
Mailing Address - Country:US
Mailing Address - Phone:985-385-3512
Mailing Address - Fax:985-385-3803
Practice Address - Street 1:1200 VICTOR II BLVD
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1350
Practice Address - Country:US
Practice Address - Phone:985-384-8788
Practice Address - Fax:985-384-8799
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACCGC # 10101Y00000X
LA241101YA0400X
DCNCAC II 005656101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)