Healthcare Provider Details

I. General information

NPI: 1679478879
Provider Name (Legal Business Name): CHRISTAL LYNN PICKELL LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2129 DILLMAN ST
TERRE HAUTE IN
47802-2919
US

IV. Provider business mailing address

2129 DILLMAN ST
TERRE HAUTE IN
47802-2919
US

V. Phone/Fax

Practice location:
  • Phone: 812-262-0908
  • Fax:
Mailing address:
  • Phone: 812-262-0908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33010186A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: