Healthcare Provider Details

I. General information

NPI: 1972125946
Provider Name (Legal Business Name): LESLEY STOCKTON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3837 N DELAWARE ST
INDIANAPOLIS IN
46205-2647
US

IV. Provider business mailing address

3837 N DELAWARE ST
INDIANAPOLIS IN
46205-2647
US

V. Phone/Fax

Practice location:
  • Phone: 812-322-5712
  • Fax:
Mailing address:
  • Phone: 812-322-5712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: