Healthcare Provider Details

I. General information

NPI: 1336499912
Provider Name (Legal Business Name): LEESA CARTER-FRANKLIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5716 GLASS CHIMNEY LN
INDIANAPOLIS IN
46235-6094
US

IV. Provider business mailing address

6626 E 75TH STREET SUITE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-289-2801
  • Fax:
Mailing address:
  • Phone: 317-621-7561
  • Fax: 317-355-6096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number34006552A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: