Provider Demographics
NPI:1104318633
Name:LEVEL WELLNESS, LLC
Entity type:Organization
Organization Name:LEVEL WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:PIPPINGER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:727-344-9607
Mailing Address - Street 1:765 60TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-1629
Mailing Address - Country:US
Mailing Address - Phone:813-505-0224
Mailing Address - Fax:
Practice Address - Street 1:360 CENTRAL AVE FL 8
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3832
Practice Address - Country:US
Practice Address - Phone:727-344-9607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1770023467Medicaid