Healthcare Provider Details

I. General information

NPI: 1619640042
Provider Name (Legal Business Name): LEAVELL COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 W 15TH AVE
COVINGTON LA
70433-3314
US

IV. Provider business mailing address

906 W 9TH AVE
COVINGTON LA
70433-2312
US

V. Phone/Fax

Practice location:
  • Phone: 985-351-0085
  • Fax:
Mailing address:
  • Phone: 985-351-0085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARY EMILY LEAVELL
Title or Position: OWNER
Credential: PHD, LPC-S
Phone: 985-351-0085