MEDICARE: KIMBERLY LEA LEVERSEE LMSW

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	101YP2500X	Professional Counselor	LCSW-22579	AZ
2	101YM0800X	Mental Health Counselor	LCSW-22579	AZ

General Provider Information

NPI Number	:	1386305118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY LEA LEVERSEE LMSW

Provider Business Mailing Address
First Line	:	633 E RAY RD STE 131
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-4206
Country	:	US
Telephone Number	:	602-345-1803
Fax Number	:

Provider Business Practice Location Address
First Line	:	633 E RAY RD STE 131
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-4206
Country	:	US
Telephone Number	:	602-345-1803
Fax Number	:

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

Provider Enumeration Date	:	01/04/2022
Last Update Date	:	06/02/2026

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