Healthcare Provider Details

I. General information

NPI: 1033995709
Provider Name (Legal Business Name): EXPAT THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3866 S EASTMONT AVE
BLOOMINGTON IN
47403-9269
US

IV. Provider business mailing address

8465 KEYSTONE CROSSING, SUITE 115 #752
INDIANAPOLIS IN
46240
US

V. Phone/Fax

Practice location:
  • Phone: 812-320-6652
  • Fax:
Mailing address:
  • Phone: 812-320-6652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LESLIE K SOMMER
Title or Position: MANAGER, THERAPIST
Credential: LCSW
Phone: 812-320-6652