Provider Demographics
NPI:1164095295
Name:LANKTON, INDIGO SKYE
Entity Type:Individual
Prefix:
First Name:INDIGO
Middle Name:SKYE
Last Name:LANKTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 TWILIGHT ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3717
Mailing Address - Country:US
Mailing Address - Phone:517-974-8420
Mailing Address - Fax:
Practice Address - Street 1:6206 W SAGINAW HWY STE B
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-2496
Practice Address - Country:US
Practice Address - Phone:517-974-8420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health