Provider Demographics
NPI:1447903380
Name:LEAVELL AND ASSOCIATES, LLC COUNSELING AND TRAUMA RECOVERY SERVICES
Entity type:Organization
Organization Name:LEAVELL AND ASSOCIATES, LLC COUNSELING AND TRAUMA RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LEAVELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:816-654-4165
Mailing Address - Street 1:3737 S ELIZABETH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-1717
Mailing Address - Country:US
Mailing Address - Phone:816-654-4165
Mailing Address - Fax:816-817-6595
Practice Address - Street 1:3737 S ELIZABETH ST STE 104
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-1717
Practice Address - Country:US
Practice Address - Phone:816-654-4165
Practice Address - Fax:816-817-6595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty