Provider Demographics
NPI:1043231491
Name:LEAVELL, HUGH R (PHD)
Entity Type:Individual
Prefix:DR
First Name:HUGH
Middle Name:R
Last Name:LEAVELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5606 PGA BLVD
Mailing Address - Street 2:SUITE 113
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-4122
Mailing Address - Country:US
Mailing Address - Phone:561-313-5233
Mailing Address - Fax:
Practice Address - Street 1:5606 PGA BLVD
Practice Address - Street 2:SUITE 113
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-4122
Practice Address - Country:US
Practice Address - Phone:561-313-5233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1132106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist