Provider Demographics
NPI:1013798636
Name:LEAVELL, NICHELLE MARIE
Entity Type:Individual
Prefix:MS
First Name:NICHELLE
Middle Name:MARIE
Last Name:LEAVELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4954 E 56TH ST STE 9
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-5769
Mailing Address - Country:US
Mailing Address - Phone:317-683-0051
Mailing Address - Fax:317-562-0905
Practice Address - Street 1:4954 E 56TH ST STE 9
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-5769
Practice Address - Country:US
Practice Address - Phone:317-683-0051
Practice Address - Fax:317-562-0905
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No251B00000XAgenciesCase Management