Basic Information
| Provider Information | |||||||||
| NPI: | 1356492664 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEAVESLEY | ||||||||
| FirstName: | GEORGANNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 137 N CLARK ST | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701195207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9857810548 | ||||||||
| FaxNumber: | 9857814319 | ||||||||
| Practice Location | |||||||||
| Address1: | 137 N CLARK ST | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701195207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9857810548 | ||||||||
| FaxNumber: | 9857814319 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | 653 | LA | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.