Provider Demographics
NPI:1982072492
Name:RAISING BASELINES
Entity type:Organization
Organization Name:RAISING BASELINES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LENISHA
Authorized Official - Middle Name:INEZ
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-362-2652
Mailing Address - Street 1:3133 MERRICK LN
Mailing Address - Street 2:1A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-1755
Mailing Address - Country:US
Mailing Address - Phone:317-362-2652
Mailing Address - Fax:317-942-0941
Practice Address - Street 1:3133 MERRICK LN
Practice Address - Street 2:1A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-1755
Practice Address - Country:US
Practice Address - Phone:317-362-2652
Practice Address - Fax:317-942-0941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health