Provider Demographics
NPI:1639138506
Name:GEARHART, STEPHEN (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:GEARHART
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 E MAIN ST
Mailing Address - Street 2:STE. 128
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-2825
Mailing Address - Country:US
Mailing Address - Phone:317-430-3215
Mailing Address - Fax:317-831-5013
Practice Address - Street 1:2680 E MAIN ST
Practice Address - Street 2:STE. 128
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-2825
Practice Address - Country:US
Practice Address - Phone:317-430-3215
Practice Address - Fax:317-831-5013
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001216A101YM0800X, 1041C0700X, 101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000316217OtherANTHEM
IN227860HMedicare ID - Type Unspecified