Provider Demographics
NPI:1467739730
Name:LEAVITT, SHELLEY E (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:E
Last Name:LEAVITT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34004 16TH AVE S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8903
Mailing Address - Country:US
Mailing Address - Phone:253-874-3630
Mailing Address - Fax:253-838-1670
Practice Address - Street 1:34004 16TH AVE S
Practice Address - Street 2:SUITE 200
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8903
Practice Address - Country:US
Practice Address - Phone:253-874-3630
Practice Address - Fax:253-838-1670
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60173033101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health