Provider Demographics
NPI:1619640042
Name:LEAVELL COUNSELING
Entity Type:Organization
Organization Name:LEAVELL COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAVELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC-S
Authorized Official - Phone:985-351-0085
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty