Healthcare Provider Details

I. General information

NPI: 1043263429
Provider Name (Legal Business Name): CHRIS C HAMM LCSW, ACSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 E US HIGHWAY 36
AVON IN
46123-8923
US

IV. Provider business mailing address

4825 OSSINGTON CT
INDIANAPOLIS IN
46254-4881
US

V. Phone/Fax

Practice location:
  • Phone: 317-272-3334
  • Fax: 317-272-3331
Mailing address:
  • Phone: 317-329-0777
  • Fax: 317-272-3331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34003714A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: