Provider Demographics
NPI:1023704632
Name:JOSEFSSON, LEVI (MT-BC)
Entity type:Individual
Prefix:
First Name:LEVI
Middle Name:
Last Name:JOSEFSSON
Suffix:
Gender:M
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2066 W 885 S
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84059-5596
Mailing Address - Country:US
Mailing Address - Phone:310-748-9271
Mailing Address - Fax:
Practice Address - Street 1:2066 W 885 S
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84059-5596
Practice Address - Country:US
Practice Address - Phone:310-748-9271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist