MS. LESLIE AS DOUGLASS (NPI# 1710104559) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710104559 |
| Entity Type | Individual |
| Full Name | MS. LESLIE AS DOUGLASS |
| Credential | LCSW |
| Practice Address |
322 N Main St Kokomo IN 46901-4622 |
| Mailing Address |
6626 E 75th Street Suite 500 Indianapolis IN 46250-2890 |
| Practice Telephone | 7654538555 |
| Practice Fax Number | 7654538020 |
| Mailing Telephone | 3176217561 |
| Mailing Fax Number | 3173556096 |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2018-12-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
34005269A | IN | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083931620 | Leslie Don Douglass | Counselor | 1922 Three Stars Rd, Edmond, OK 73034-3118 | 2010-04-21 |
| Street Address |
322 N MAIN ST |
| City | KOKOMO |
| State | IN |
| Zip Code | 46901-4622 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407830599 | Matthew Nathaniel Isaac Oliver | Psychologist | 322 N Main St, Kokomo, IN 46901-4622 | 2005-12-01 |
| 1558906685 | Jovan Shumpert | Counselor | 322 N Main St, Kokomo, IN 46901-4622 | 2019-11-13 |
| 1467096339 | Matthew Matteson | Social Worker | 322 N Main St, Kokomo, IN 46901-4622 | 2019-11-04 |
| 1265994180 | Lindsey N Morgan | Nurse Practitioner | 322 N Main St, Kokomo, IN 46901-4622 | 2019-04-01 |
| 1679099055 | Kyle Roussey | Social Worker | 322 N Main St, Kokomo, IN 46901-4622 | 2017-08-17 |
| 1962869917 | Marie Yager | Social Worker | 322 N Main St, Kokomo, IN 46901-4622 | 2016-01-21 |
| 1235505942 | Greg Edie | Social Worker | 322 N Main St, Kokomo, IN 46901 | 2015-08-17 |
| 1770975328 | Jennifer Ashlee Cramer | Counselor | 322 N Main St, Kokomo, IN 46901-4622 | 2015-02-19 |
| 1134526304 | Amanda Serie | Social Worker | 322 N Main St, Kokomo, IN 46901-4622 | 2014-12-03 |
| 1386084556 | Bobbi J Siccardi | Social Worker | 322 N Main St, Kokomo, IN 46901 | 2013-07-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922607597 | Momentum Kokomo, LLC | Substance Abuse Rehabilitation Facility | 1236 N. Wabash Ave, Kokomo, IN 46901 | 2020-10-23 |
| 1457826869 | Jodi Gayle Lake | Developmental Therapist | 2523 Lorentson Ct, Kokomo, IN 46901 | 2018-10-11 |
| 1871088369 | Hope Behavioral Servies, LLC | Behavioral Analyst | 924 Clark St, Kokomo, IN 46901 | 2018-06-27 |
| 1255782306 | Forefront Dermatology, S.c. | Dermatology | 2130 W Sycamore St Ste 200, Kokomo, IN 46901 | 2016-06-29 |
| 1164860706 | Renee Michelle Brown | Registered Nurse | 2776 Amberwood Place, Kokomo, IN 46901 | 2013-06-05 |
| 1063642916 | Michelle K Rush | Speech-Language Pathologist | 2532 Lauren Ln, Kokomo, IN 46901 | 2009-07-24 |
| 1396957189 | Lifetime Dental Care of In, PC | Dentist | 927 S Washington St, Kokomo, IN 46901 | 2007-05-04 |
| 1245458355 | Wagoner Medical Center, LLC | Internal Medicine | 2016 W Sycamore, Kokomo, IN 46901 | 2007-04-23 |
| 1053442723 | Jesusa Salhieh | Contractor | Genesis Rehab Bloom, Kokomo, IN 46901 | 2007-03-07 |
| 1740382928 | Donald A Fantuzzo Dds PC | Dentist | 2196 W Sycamore St, Kokomo, IN 46901 | 2006-09-01 |
| Find all providers in zip 46901 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902406747 | Abigail A Campbell | Counselor | 2660 Sea Biscuit Ln, Kokomo, IN 46901-5093 | 2020-10-30 |
| 1043826175 | Emily Brianne Edwards | Counselor | 217 E Southway Blvd, Kokomo, IN 46902-3698 | 2020-09-23 |
| 1982244687 | John Gilbert Stark Jr. | Counselor | 417 Arnold Ct, Kokomo, IN 46902-3702 | 2020-01-10 |
| 1366925257 | John Robert Lawson | Counselor | 700 E Firmin St Ste 182, Kokomo, IN 46902-2350 | 2018-09-07 |
| 1902301807 | Donald W Ridenour | Counselor | 1520 W Mulberry St, Kokomo, IN 46901-4272 | 2018-03-24 |
| 1063812899 | Gabriel Valentine | Counselor | 1613 South Elizabeth St, Apt 1b, Kokomo, IN 46902 | 2014-08-28 |
| 1174828917 | Dianna Spray Rudd | Counselor | 522 W Jackson St, Kokomo, IN 46901-4440 | 2011-01-25 |
| 1154653426 | Family Piece LLC | Counselor | 4254 S 00 Ew, Kokomo, IN 46902-5205 | 2010-02-11 |
| 1154653780 | Daniel Paul Price | Counselor | 2205 Glenora Ct, Kokomo, IN 46902-3195 | 2010-02-07 |
| 1679707145 | Elizabeth Barnett | Counselor | 1425 N Bell St, Kokomo, IN 46901-2302 | 2009-05-12 |
| Find all providers in KOKOMO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.