Provider Demographics
NPI:1497243653
Name:LEEDS, CHELSEA S (ATR-BC, LMHC)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:S
Last Name:LEEDS
Suffix:
Gender:F
Credentials:ATR-BC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 POLK ST STE 6C
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1647
Mailing Address - Country:US
Mailing Address - Phone:317-458-5894
Mailing Address - Fax:317-981-1652
Practice Address - Street 1:500 POLK ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1628
Practice Address - Country:US
Practice Address - Phone:317-458-5894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003261A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN39003261AOtherINDIANA LICENSING BOARD