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General NPI Number Information
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NPI Number | 1578923405
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Entity Type | Organization
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Legal Business Name | DEIDRA STOREY
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Dates
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Enumeration Date | 03/04/2016
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Last Update Date | 01/26/2024
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Provider Practice Location Address
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Address Line | 941 E 86TH ST STE 120
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-1842
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Country | US
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Telephone | 812-631-0056
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Fax |
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Provider Business Mailing Address
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Address Line | 18773 WYCHWOOD PL
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City | NOBLESVILLE
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State | IN
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Zip | 46062-7544
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Country | US
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Telephone | 812-631-0056
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELOR
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Name | MRS. DEIDRA LYNN STOREY
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Credential | LMHC
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Telephone | 812-631-0056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 39001108A
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License Number State | IN
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