Healthcare Provider Details

I. General information

NPI: 1215271382
Provider Name (Legal Business Name): WITHIN SIGHT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 VANN AVE
EVANSVILLE IN
47714-1444
US

IV. Provider business mailing address

15 VANN AVE
EVANSVILLE IN
47714-1444
US

V. Phone/Fax

Practice location:
  • Phone: 812-402-8333
  • Fax: 812-402-8331
Mailing address:
  • Phone: 812-402-8333
  • Fax: 812-402-8331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34004020A
License Number StateIN

VIII. Authorized Official

Name: MS. CARON JEANNE LEADER
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LCSW
Phone: 812-402-8333