Provider Demographics
NPI:1811752504
Name:STARK, LEAH (LMHCA)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:STARK
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6536 STONE CROSSING DR APT D
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-2293
Mailing Address - Country:US
Mailing Address - Phone:607-427-7963
Mailing Address - Fax:
Practice Address - Street 1:5660 CAITO DR STE 126
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-1368
Practice Address - Country:US
Practice Address - Phone:317-296-5632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88002279A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health