Provider Demographics
NPI:1235295189
Name:STEWART, SALLY LYNN (LMFT)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:LYNN
Last Name:STEWART
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1556 N OLD HIGHWAY 135
Mailing Address - Street 2:P.O. BOX 907
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-2002
Mailing Address - Country:US
Mailing Address - Phone:812-738-3277
Mailing Address - Fax:812-738-4092
Practice Address - Street 1:1556 N OLD HIGHWAY 135
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-2002
Practice Address - Country:US
Practice Address - Phone:812-738-3277
Practice Address - Fax:812-738-4092
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001451A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health