Provider Demographics
NPI:1235286063
Name:LEAVENWORTH, CAROL (MSED, LPC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:LEAVENWORTH
Suffix:
Gender:F
Credentials:MSED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 S LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-4030
Mailing Address - Country:US
Mailing Address - Phone:303-830-0905
Mailing Address - Fax:303-830-0599
Practice Address - Street 1:673 GRANT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-3506
Practice Address - Country:US
Practice Address - Phone:303-830-0905
Practice Address - Fax:303-830-0599
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO109101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health