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General NPI Number Information
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NPI Number | 1033995709
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Entity Type | Organization
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Legal Business Name | EXPAT THERAPY LLC
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Dates
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Enumeration Date | 09/07/2023
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 3866 S EASTMONT AVE
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City | BLOOMINGTON
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State | IN
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Zip | 47403-9269
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Country | US
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Telephone | 812-320-6652
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Fax |
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Provider Business Mailing Address
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Address Line | 8465 KEYSTONE CROSSING, SUITE 115 #752
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City | INDIANAPOLIS
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State | IN
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Zip | 46240
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Country | US
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Telephone | 812-320-6652
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Fax |
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Authorized Official
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Title or Position | MANAGER, THERAPIST
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Name | LESLIE K SOMMER
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Credential | LCSW
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Telephone | 812-320-6652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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