Provider Demographics
NPI:1043817745
Name:WHITMIRE, LEAH (MA, MT-BC)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:WHITMIRE
Suffix:
Gender:F
Credentials:MA, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5160 CARVEL AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-1273
Mailing Address - Country:US
Mailing Address - Phone:479-747-9346
Mailing Address - Fax:
Practice Address - Street 1:4201 MILLERSVILLE RD STE 204
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2987
Practice Address - Country:US
Practice Address - Phone:479-747-9346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
10514225A00000X
IN39005266A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist