Provider Demographics
NPI:1558706408
Name:STOREY, DEIDRA (LSW, LMHC)
Entity Type:Individual
Prefix:
First Name:DEIDRA
Middle Name:
Last Name:STOREY
Suffix:
Gender:F
Credentials:LSW, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3850
Mailing Address - Country:US
Mailing Address - Phone:765-450-4843
Mailing Address - Fax:
Practice Address - Street 1:941 E 86TH ST STE 120
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1842
Practice Address - Country:US
Practice Address - Phone:812-631-0056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN452541282101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health