Individual provider · Type 1 NPI

Mallory Leatherman 19

Mental Health Counselor · Fort Wayne, IN

NPI number 1659932069 Active

Practice location

3900 Hursh Rd
Fort Wayne, IN 46845-9677

Call (260) 637-3608 Map

Mailing address

8515 Bluffton Rd
Fort Wayne, IN 46809-3022

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XNone listed

Mental Health Counselor: Definition to come...

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About NPI 1659932069

Mallory Leatherman 19's National Provider Identifier is 1659932069, issued on Jun 26, 2019. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Fort Wayne, IN. The record was last updated on Sep 29, 2026.