Healthcare Provider Details

I. General information

NPI: 1497246888
Provider Name (Legal Business Name): SARA LEHR CORRY MA, LMHC, CCTP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARA L. CORRY MA, LMHC

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 Q ST.
BEDFORD IN
47421
US

IV. Provider business mailing address

5211 N. BRUMMETTS CREEK RD
BLOOMINGTON IN
47408
US

V. Phone/Fax

Practice location:
  • Phone: 812-279-4673
  • Fax: 812-279-4672
Mailing address:
  • Phone: 812-272-8060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0081291
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0126551
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39003435A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0126551
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: