Provider Demographics
NPI:1871709923
Name:EVERETT, LEAH DAWN (LPC)
Entity type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:DAWN
Last Name:EVERETT
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 1:1905 LINWOOD DR STE 2
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-6235
Mailing Address - Country:US
Mailing Address - Phone:870-637-0472
Mailing Address - Fax:870-292-3555
Practice Address - Street 1:1905 LINWOOD DR STE 2
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-6235
Practice Address - Country:US
Practice Address - Phone:870-637-0472
Practice Address - Fax:870-292-3555
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1112099101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5V987OtherBCBS
AR173613795Medicaid