Provider Demographics
NPI:1720460660
Name:MOWERY, STEPHANIE (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MOWERY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6507 FERGUSON ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1294
Mailing Address - Country:US
Mailing Address - Phone:317-819-8337
Mailing Address - Fax:317-819-8332
Practice Address - Street 1:6507 FERGUSON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-1294
Practice Address - Country:US
Practice Address - Phone:317-819-8337
Practice Address - Fax:317-819-8332
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-27
Last Update Date:2015-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007240A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical