Provider Demographics
NPI:1578384640
Name:BENTLEY, LEVI (PRE-LPC)
Entity type:Individual
Prefix:
First Name:LEVI
Middle Name:
Last Name:BENTLEY
Suffix:
Gender:X
Credentials:PRE-LPC
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4925 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-3306
Mailing Address - Country:US
Mailing Address - Phone:360-775-1798
Mailing Address - Fax:360-775-1798
Practice Address - Street 1:4925 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-1914
Practice Address - Country:US
Practice Address - Phone:360-775-1798
Practice Address - Fax:360-775-1798
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health