Individual
MR. JOHN ROBERT LEAVELL III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA. LPC
Contact information
Practice address
208 W AUSTIN ST, BROKEN ARROW, OK 74011-3605
(918) 451-0876
Mailing address
208 W AUSTIN ST, BROKEN ARROW, OK 74011-3605
(918) 451-0876
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3648
OK
Other
Enumeration date
10/26/2006
Last updated
07/08/2007
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