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General NPI Number Information
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NPI Number | 1447903380
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Entity Type | Organization
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Legal Business Name | LEAVELL AND ASSOCIATES, LLC COUNSELING AND TRAUMA RECOVERY SERVICES
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Dates
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Enumeration Date | 02/01/2022
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Last Update Date | 02/01/2022
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Provider Practice Location Address
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Address Line | 3737 S ELIZABETH ST STE 104
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City | INDEPENDENCE
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State | MO
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Zip | 64057-1717
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Country | US
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Telephone | 816-654-4165
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Fax | 816-817-6595
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Provider Business Mailing Address
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Address Line | 3737 S ELIZABETH ST STE 104
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City | INDEPENDENCE
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State | MO
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Zip | 64057-1717
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Country | US
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Telephone | 816-654-4165
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Fax | 816-817-6595
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. MARK DAVID LEAVELL
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Credential | LCSW
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Telephone | 816-654-4165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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