Provider Demographics
NPI:1942317177
Name:LEVINE, MARC EDWARD (LMFT)
Entity type:Individual
Prefix:MR
First Name:MARC
Middle Name:EDWARD
Last Name:LEVINE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 130TH AVE NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005
Mailing Address - Country:US
Mailing Address - Phone:425-457-7070
Mailing Address - Fax:425-283-0443
Practice Address - Street 1:2310 130TH AVE NE
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005
Practice Address - Country:US
Practice Address - Phone:425-457-7070
Practice Address - Fax:425-283-0443
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001290101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALF00001290OtherMARRIAGE FAMILY THERAPIST
WALF00001290OtherMARRIAGE FAMILY THERAPIST