Provider Demographics
NPI:1952541047
Name:LEIVA, MARYLIN ESTHER (LPC)
Entity type:Individual
Prefix:
First Name:MARYLIN
Middle Name:ESTHER
Last Name:LEIVA
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 1:4 NW PECAN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9640
Mailing Address - Country:US
Mailing Address - Phone:580-284-5902
Mailing Address - Fax:
Practice Address - Street 1:4 NW PECAN VALLEY DR
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9640
Practice Address - Country:US
Practice Address - Phone:580-284-5902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3818101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health