Healthcare Provider Details

I. General information

NPI: 1881466332
Provider Name (Legal Business Name): CHANTYL JIMIKA TROUPE MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2023
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 WINDSOR CT SUITE B
ELKHART IN
46514-5556
US

IV. Provider business mailing address

1222 FARM CREST CIR APT 2A
MISHAWAKA IN
46544-8018
US

V. Phone/Fax

Practice location:
  • Phone: 574-267-1700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33009484A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: