Provider Demographics
NPI:1235319963
Name:STONER, J ANDREW (MDIV DMIN LMFT LMHC)
Entity Type:Individual
Prefix:MR
First Name:J
Middle Name:ANDREW
Last Name:STONER
Suffix:
Gender:M
Credentials:MDIV DMIN LMFT LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11026 OLD OAK TRAIL
Mailing Address - Street 2:
Mailing Address - City:FT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-9481
Mailing Address - Country:US
Mailing Address - Phone:260-668-8797
Mailing Address - Fax:260-665-1620
Practice Address - Street 1:430 N WAYNE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703
Practice Address - Country:US
Practice Address - Phone:260-668-8797
Practice Address - Fax:260-665-1620
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001026A101YM0800X
IN35001061A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health