Provider Demographics
NPI:1073248373
Name:LEAVELL, JEREMY (LPC ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:LEAVELL
Suffix:
Gender:M
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 S CAPITAL OF TEXAS HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6561
Mailing Address - Country:US
Mailing Address - Phone:512-981-8787
Mailing Address - Fax:
Practice Address - Street 1:1715 S CAPITAL OF TEXAS HWY STE 201
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6561
Practice Address - Country:US
Practice Address - Phone:512-981-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional