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Individual

MR. MICHAEL ROLAND LEVEQUE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PSYD

Contact information

Practice address
600 S TAYLOR AVE, DEPT PSYCHIATRY, STE 122, SAINT LOUIS, MO 63110-1035
(314) 286-1700
(314) 362-7017
Mailing address
600 S TAYLOR AVE, DEPT PSYCHIATRY, STE 122, SAINT LOUIS, MO 63110-1035
(314) 286-1700
(314) 362-7017

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2012001790
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
490025973
MO
Enumeration date
03/06/2013
Last updated
11/15/2021
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