Provider Demographics
NPI:1346619970
Name:LEAVELL, MARY EMILY MATHENY
Entity Type:Individual
Prefix:DR
First Name:MARY EMILY
Middle Name:MATHENY
Last Name:LEAVELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 W 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-2312
Mailing Address - Country:US
Mailing Address - Phone:985-351-0085
Mailing Address - Fax:
Practice Address - Street 1:604 W 15TH AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-3314
Practice Address - Country:US
Practice Address - Phone:985-351-0085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional