Carly D. L. Lebaron, PH.D., LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

7820799-3902 Issued in UT

Practice address

95 Golf Course Rd Ste 105
Logan, UT 84321-5990

Phone

(435) 915-6398

NPI assigned

Aug 15, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 17, 2024 through Jan 17, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Embracing Authenticity Inc

  • Multi-Specialty Clinic/Center
  • Logan, UT
  • NPI 1558129221
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1376524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709769600000",
    "number": "1013340801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 GOLF COURSE RD STE 105",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843215990",
            "telephone_number": "435-915-6398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 GOLF COURSE RD STE 105",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843215990",
            "telephone_number": "435-915-6398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEBARON",
        "first_name": "CARLY",
        "middle_name": "D. L.",
        "name_prefix": "Dr.",
        "credential": "PH.D., LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-15",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "UT",
            "license": "7820799-3902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ilene F Lazenby
• Brenda Elizabeth Lazzari
• LDS Family Services
• Learngrow, LLC
• Wendy Lynne Leavitt, M.D.
• Christina Ledesma
• Lee S. Broadbent, M.D. Apc
• Travis Roger Lee, STUDENT
• Lees Marketplace Inc
• Allie Leezer, CSW

• Marriage & Family Therapist in Logan, UT
• Providers in Logan, UT by specialty
• Marriage & Family Therapist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.