Provider Demographics
NPI:1578923405
Name:DEIDRA STOREY
Entity Type:Organization
Organization Name:DEIDRA STOREY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEIDRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:STOREY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:812-631-0056
Mailing Address - Street 1:18773 WYCHWOOD PL
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-7544
Mailing Address - Country:US
Mailing Address - Phone:812-631-0056
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001108A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty