MEDICARE: CHRISTIAN KELLER DECK LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	34009578A	IN

General Provider Information

NPI Number	:	1861143604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN KELLER DECK LCSW

Provider Business Mailing Address
First Line	:	5868 E 71ST ST STE E-679
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-4075
Country	:	US
Telephone Number	:	317-721-1336
Fax Number	:

Provider Business Practice Location Address
First Line	:	5868 E 71ST ST STE E-679
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-4075
Country	:	US
Telephone Number	:	317-721-1336
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2022
Last Update Date	:	06/22/2024

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