Healthcare Provider Details

I. General information

NPI: 1710544317
Provider Name (Legal Business Name): CHRISTOPHER ARMENTROUT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 PARK PL W STE 150
MISHAWAKA IN
46545-3565
US

IV. Provider business mailing address

16970 WOODSHIRE CT
GRANGER IN
46530-9787
US

V. Phone/Fax

Practice location:
  • Phone: 574-282-1090
  • Fax:
Mailing address:
  • Phone: 574-274-5664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34010608A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: