Provider Demographics
NPI:1275983140
Name:RIELAGE-RALPH, LESLIE (LCPC, LMHC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:RIELAGE-RALPH
Suffix:
Gender:F
Credentials:LCPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 E MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1457
Mailing Address - Country:US
Mailing Address - Phone:317-743-8202
Mailing Address - Fax:
Practice Address - Street 1:435 E MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1457
Practice Address - Country:US
Practice Address - Phone:317-743-8202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.010290101YM0800X
IN39004238A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health