Provider Demographics
NPI:1275258667
Name:SOMMER, LESLIE (LCSW)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:SOMMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8465 KEYSTONE CROSSING, SUITE 115 #752
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240
Mailing Address - Country:US
Mailing Address - Phone:812-320-6652
Mailing Address - Fax:
Practice Address - Street 1:8465 KEYSTONE CROSSING, SUITE 115 #752
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240
Practice Address - Country:US
Practice Address - Phone:812-320-6652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33010336A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health