Healthcare Provider Details

I. General information

NPI: 1134655228
Provider Name (Legal Business Name): AMY CHENAULT LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY CHENAULT STONE LMFT

II. Dates (important events)

Enumeration Date: 05/10/2017
Last Update Date: 08/09/2020
Certification Date: 08/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 E MAIN ST STE 335
PLAINFIELD IN
46168-2825
US

IV. Provider business mailing address

PO BOX 451
PLAINFIELD IN
46168-0451
US

V. Phone/Fax

Practice location:
  • Phone: 317-537-1448
  • Fax:
Mailing address:
  • Phone: 317-537-1448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number108504
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35002084A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: