| Leslie As Douglass Licensed Clinical Social Worker Llc | |
|
55 W. Washington St. Frankfort IN 46041-1923 | |
| (765) 357-8118 | |
| (765) 766-4241 |
| Full Name | Leslie As Douglass Licensed Clinical Social Worker Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 55 W. Washington St., Frankfort, Indiana |
| Authorized Official Name and Position | Leslie As Douglass (PRESIDENT/OWNER) |
| Authorized Official Contact | 7653578118 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Leslie As Douglass Licensed Clinical Social Worker Llc Po Box 397 Frankfort IN 46041-0397 Ph: (765) 357-8118 | Leslie As Douglass Licensed Clinical Social Worker Llc 55 W. Washington St. Frankfort IN 46041-1923 Ph: (765) 357-8118 |
| NPI Number | 1316985088 |
|---|---|
| Provider Enumeration Date | 06/03/2006 |
| Last Update Date | 11/19/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316985088 | NPI | - | NPPES |
| 200461950 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 33003543A (Indiana) | Primary |
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