Provider Demographics
NPI:1013340801
Name:LEBARON, CARLY D L (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:CARLY
Middle Name:D L
Last Name:LEBARON
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 GOLF COURSE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-5990
Mailing Address - Country:US
Mailing Address - Phone:435-915-6398
Mailing Address - Fax:
Practice Address - Street 1:95 GOLF COURSE RD STE 105
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-5990
Practice Address - Country:US
Practice Address - Phone:435-915-6398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7820799-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist