Organization
SIX RIVERS COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRAD W LEVITT PSYD (CLINICAL PSYCHOLOGIST)
(208) 452-7190
Entity
Organization
Contact information
Practice address
182 SW 10TH ST, ONTARIO, OR 97914-2134
(208) 452-7190
Mailing address
182 SW 10TH ST, ONTARIO, OR 97914-2134
(208) 452-7190
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY-119
OR
103TC0700X
Clinical Psychologist
PSY-202138
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805206300
—
ID
Enumeration date
06/19/2007
Last updated
06/26/2008
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