Healthcare Provider Details

I. General information

NPI: 1407824055
Provider Name (Legal Business Name): LEAH J FREELAND LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N. LEBANON ST.
LEBANON IN
46052-1716
US

IV. Provider business mailing address

610 N LEBANON ST
LEBANON IN
46052-1716
US

V. Phone/Fax

Practice location:
  • Phone: 765-680-0071
  • Fax: 765-680-0468
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39000272A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: