Healthcare Provider Details

I. General information

NPI: 1801712112
Provider Name (Legal Business Name): CAMDEN CHAFFEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 LINCOLN WAY E STE 200
SOUTH BEND IN
46601-3215
US

IV. Provider business mailing address

402 E FAIRVIEW AVE
SOUTH BEND IN
46614-1135
US

V. Phone/Fax

Practice location:
  • Phone: 574-360-4066
  • Fax:
Mailing address:
  • Phone: 574-360-4066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number33013709A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: