Provider Demographics
NPI:1255472643
Name:CLARDY, DEBORAH KAY (LMHC)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:KAY
Last Name:CLARDY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:KAY
Other - Last Name:COOK-CLARDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:4308 HICKORY RD
Mailing Address - Street 2:APT. 1-D
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-8529
Mailing Address - Country:US
Mailing Address - Phone:574-309-4295
Mailing Address - Fax:
Practice Address - Street 1:53846 GENERATIONS DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1543
Practice Address - Country:US
Practice Address - Phone:574-243-9370
Practice Address - Fax:574-243-9375
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IN39001868A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor