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NPI Code Detail

MEDICARE: LEISA WATKINS LMFT

MEDICARE: LEISA WATKINS LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistLMFT-7510ID
2106H00000XMarriage & Family Therapist35002409AIN

General Provider Information

NPI Number : 1932636925
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEISA WATKINS LMFT
Provider Business Mailing Address
First Line : 12011 EMORY DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46229-9737
Country : US
Telephone Number : 208-552-4831
Fax Number :
Provider Business Practice Location Address
First Line : 12011 EMORY DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46229-9737
Country : US
Telephone Number : 208-552-4831
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2017
Last Update Date : 04/28/2026

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