Provider Demographics
NPI:1669081311
Name:LEAVITT, CATHERINE (LPC)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:LEAVITT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:LEAVITT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:472 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-5086
Mailing Address - Country:US
Mailing Address - Phone:208-232-2190
Mailing Address - Fax:
Practice Address - Street 1:472 VISTA DR
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5086
Practice Address - Country:US
Practice Address - Phone:888-457-1776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID101YP2500X
IDLPC-8189101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional