Provider Demographics
NPI:1184772402
Name:LEVERETT, JENNIFER A (LMHC, NCC, LIMHP)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:A
Last Name:LEVERETT
Suffix:
Gender:F
Credentials:LMHC, NCC, LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14679 230TH ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-7223
Mailing Address - Country:US
Mailing Address - Phone:712-314-3326
Mailing Address - Fax:
Practice Address - Street 1:14679 230TH ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-7223
Practice Address - Country:US
Practice Address - Phone:712-314-3326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT15634251S00000X
IA961101YM0800X
NE3298101YM0800X
NE2612101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5707373Medicaid