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Individual

KERRY E LEAVELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCPC, MT-BC

Contact information

Practice address
170 2ND ST S, NAMPA, ID 83651-3708
(208) 385-3650
(208) 385-3651
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LCPC-5678
ID
101Y00000X
Counselor
LPC - 4675
ID
101YM0800X
Mental Health Counselor
LPC - 4675
ID
101YP2500X
Professional Counselor
LPC - 4675
ID
225A00000X
Music Therapist

Other

Enumeration date
02/14/2011
Last updated
12/04/2023
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