Provider Demographics
NPI:1407567472
Name:SEWELL, AMBER (LMHCA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:SEWELL
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:LEO
Mailing Address - State:IN
Mailing Address - Zip Code:46765-9557
Mailing Address - Country:US
Mailing Address - Phone:260-349-2397
Mailing Address - Fax:
Practice Address - Street 1:4630 W JEFFERSON BLVD STE 3
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6800
Practice Address - Country:US
Practice Address - Phone:260-349-2397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99115602A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health