Individual
PHYLLIS E. LEAVITT
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
208 LAS MANANITAS ST, SANTA FE, NM 87501-1546
(505) 986-0756
(505) 983-4638
Mailing address
208 LAS MANANITAS ST, SANTA FE, NM 87501-1546
(505) 986-0756
(505) 983-4638
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1301
NM
106H00000X
Marriage & Family Therapist
1835
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
54108730
—
NM
Enumeration date
03/09/2006
Last updated
09/11/2025
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