Healthcare Provider Details

I. General information

NPI: 1447863634
Provider Name (Legal Business Name): HILLARY ANNE LEVERGOOD LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6211 W WILLOW HWY # 199
LANSING MI
48917-1231
US

IV. Provider business mailing address

6211 W WILLOW HWY # 199
LANSING MI
48917-1231
US

V. Phone/Fax

Practice location:
  • Phone: 630-310-2821
  • Fax:
Mailing address:
  • Phone: 630-310-2821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401018453
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: