Provider Demographics
NPI:1952076325
Name:LEAVITT, ALLISON KAY (LPC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:KAY
Last Name:LEAVITT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3107 TREYBURN LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIEL
Mailing Address - State:TX
Mailing Address - Zip Code:76084-1141
Mailing Address - Country:US
Mailing Address - Phone:314-750-2330
Mailing Address - Fax:
Practice Address - Street 1:3107 TREYBURN LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76084-1141
Practice Address - Country:US
Practice Address - Phone:314-750-2330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90105101YM0800X
MO2013018120101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional