Provider Demographics
NPI:1447599717
Name:LEAVITT, JEREMY (MS, LMFT, CADCI)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:LEAVITT
Suffix:
Gender:M
Credentials:MS, LMFT, CADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9120 SILK THREADS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-0609
Mailing Address - Country:US
Mailing Address - Phone:702-769-7441
Mailing Address - Fax:
Practice Address - Street 1:2620 REGATTA DR
Practice Address - Street 2:SUITE 102
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-6891
Practice Address - Country:US
Practice Address - Phone:702-769-7441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10761101Y00000X
101YA0400X
NV01324106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)