Provider Demographics
NPI:1861736217
Name:LEAVITT, TONY LEE (MMHC)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:LEE
Last Name:LEAVITT
Suffix:
Gender:M
Credentials:MMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4-831 KUHIO HWY STE 438
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-1574
Mailing Address - Country:US
Mailing Address - Phone:541-613-5646
Mailing Address - Fax:
Practice Address - Street 1:4-831 KUHIO HWY STE 438
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1574
Practice Address - Country:US
Practice Address - Phone:541-613-5646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-23
Last Update Date:2012-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor