Provider Demographics
NPI:1609179340
Name:STEURY-JOHNSON, KYNA (LMHC)
Entity Type:Individual
Prefix:
First Name:KYNA
Middle Name:
Last Name:STEURY-JOHNSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12606 LEO RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-9205
Mailing Address - Country:US
Mailing Address - Phone:260-222-8307
Mailing Address - Fax:
Practice Address - Street 1:12606 LEO RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-9205
Practice Address - Country:US
Practice Address - Phone:260-222-8307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002679A101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200912670AMedicaid
IN261420Medicare PIN