Diederich, Chris

Diederich, Chris is an individual health care provider with primary practice located at 2040 N Shadeland Ave Ste 250, Indianapolis IN 46219-1711. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Diederich, Chris can be contacted via phone (317) 355-5009.

Contact Information

Primary practice address
2040 N Shadeland Ave Ste 250 Indianapolis IN 46219-1711
Phone: (317) 355-5009
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 39000598A Indiana
Behavioral Health & Social Service Providers / Clinical 1041C0700X 34004362A Indiana

Profile Details

NPI number 1821016700
LBN Legal business name Diederich, Chris
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 18th, 2006
Last updated Apr 12th, 2018 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821016700 NPPES
Indiana Other 000000390191 ANTHEM BCBS PROVIDER PIN

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