MEDICARE: MS. CAROL LEAVENWORTH M.S.ED., LPC

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	101YM0800X	Mental Health Counselor	109	CO

General Provider Information

NPI Number	:	1235286063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL LEAVENWORTH M.S.ED., LPC

Provider Business Mailing Address
First Line	:	2032 S LOGAN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-4030
Country	:	US
Telephone Number	:	303-830-0905
Fax Number	:	303-830-0599

Provider Business Practice Location Address
First Line	:	673 GRANT ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-3506
Country	:	US
Telephone Number	:	303-830-0905
Fax Number	:	303-830-0599

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	11/05/2008

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Directions to “ MS. CAROL LEAVENWORTH M.S.ED., LPC” Practice Location

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