Individual
LIESA ETHERIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
205 N JACKSON ST, FRANKFORT, IN 46041-1936
(765) 659-4771
Mailing address
6626 E 75TH ST, STE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39002925A
IN
Other
Enumeration date
09/30/2016
Last updated
09/30/2016
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