MEDICARE: DR. HUGH R LEAVELL PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MT1132	FL

General Provider Information

NPI Number	:	1043231491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HUGH R LEAVELL PH.D.

Provider Business Mailing Address
First Line	:	5606 PGA BLVD
Second Line	:	SUITE 113
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-4122
Country	:	US
Telephone Number	:	561-313-5233
Fax Number	:

Provider Business Practice Location Address
First Line	:	5606 PGA BLVD
Second Line	:	SUITE 113
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-4122
Country	:	US
Telephone Number	:	561-313-5233
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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