Provider Demographics
NPI:1740838408
Name:LEAVERTON, JASON (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:LEAVERTON
Suffix:
Gender:M
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 RED COAT RUN
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5334
Mailing Address - Country:US
Mailing Address - Phone:931-208-2103
Mailing Address - Fax:
Practice Address - Street 1:301 RED COAT RUN
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5334
Practice Address - Country:US
Practice Address - Phone:931-208-2103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TN5109101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health