Healthcare Provider Details

I. General information

NPI: 1972878387
Provider Name (Legal Business Name): LEEVER MENTAL HEALTH COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 03/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 SW SAINT LUCIE CRES SUITE 106
STUART FL
34994-2851
US

IV. Provider business mailing address

607 SW SAINT LUCIE CRES SUITE 106
STUART FL
34994-2851
US

V. Phone/Fax

Practice location:
  • Phone: 772-233-9982
  • Fax: 772-872-6176
Mailing address:
  • Phone: 772-233-9982
  • Fax: 772-872-6176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ERIC RAY LEEVER
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential: LMHC
Phone: 772-233-9982