MEDICARE: RAISING BASELINES

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
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1982072492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAISING BASELINES

Provider Business Mailing Address
First Line	:	3133 MERRICK LN
Second Line	:	1A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-1755
Country	:	US
Telephone Number	:	317-362-2652
Fax Number	:	317-942-0941

Provider Business Practice Location Address
First Line	:	3133 MERRICK LN
Second Line	:	1A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-1755
Country	:	US
Telephone Number	:	317-362-2652
Fax Number	:	317-942-0941

Authorized Official
Title or Position	:	THERAPIST
Name	:	LENISHA INEZ WATSON
Credential	:
Telephone Number	:	317-362-2652

Provider Enumeration Date	:	09/14/2015
Last Update Date	:	09/14/2015

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Directions to “RAISING BASELINES ” Practice Location

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