Individual
MS. LISA MICHELLE LEAVITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1500 WSC, BRIGHAM YOUNG UNIVERSITY, PROVO, UT 84602
(801) 422-3035
Mailing address
1500 WSC, BRIGHAM YOUNG UNIVERSITY, PROVO, UT 84602
(801) 422-3035
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6096071-2501
UT
Other
Enumeration date
10/28/2010
Last updated
10/28/2010
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