MEDICARE: DEIDRA STOREY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	39001108A	IN

General Provider Information

NPI Number	:	1578923405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEIDRA STOREY

Provider Business Mailing Address
First Line	:	18773 WYCHWOOD PL
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46062-7544
Country	:	US
Telephone Number	:	812-631-0056
Fax Number	:

Provider Business Practice Location Address
First Line	:	941 E 86TH ST STE 120
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-1842
Country	:	US
Telephone Number	:	812-631-0056
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH COUNSELOR
Name	:	MRS. DEIDRA LYNN STOREY
Credential	:	LMHC
Telephone Number	:	812-631-0056

Provider Enumeration Date	:	03/04/2016
Last Update Date	:	01/26/2024

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Directions to “DEIDRA STOREY ” Practice Location

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