| Leva Neuroscience Llc | |
|
1817 Lewis Turner Blvd Ste D Fort Walton Beach FL 32547-1349 | |
| (561) 727-0040 | |
| Not Available |
| Full Name | Leva Neuroscience Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1817 Lewis Turner Blvd Ste D, Fort Walton Beach, Florida |
| Authorized Official Name and Position | Pashia Groom (OWNER) |
| Authorized Official Contact | 8504954908 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Leva Neuroscience Llc 1817 Lewis Turner Blvd Ste D Fort Walton Beach FL 32547-1349 Ph: () - | Leva Neuroscience Llc 1817 Lewis Turner Blvd Ste D Fort Walton Beach FL 32547-1349 Ph: (561) 727-0040 |
| NPI Number | 1841068772 |
|---|---|
| Provider Enumeration Date | 12/20/2023 |
| Last Update Date | 12/20/2023 |
| Certification Date | 12/20/2023 |
| Medicare PECOS PAC ID | 3173969078 |
|---|---|
| Medicare Enrollment ID | O20240314000833 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841068772 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Pashia D Groom |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1972696839 PECOS PAC ID: 9436053261 Enrollment ID: I20050329000327 |
| Provider Name | Elizabeth Roylance Ault |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619310257 PECOS PAC ID: 9234430604 Enrollment ID: I20210511002292 |
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