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General NPI Number Information
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NPI Number | 1760566046
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Entity Type | Individual
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Provider Name | CHUCK CICHANOWICZ LMHC,MS,M.DIV,IMAC,
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Gender | Male
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3768 ROME DRIVE
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City | LAFAYETTE
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State | IN
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Zip | 47905
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Country | US
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Telephone | 765-449-9115
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Fax | 765-446-4224
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Provider Business Mailing Address
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Address Line | 106 CANDLELIGHT PLZ
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City | WEST LAFAYETTE BRA
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State | IN
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Zip | 47906-5628
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Country | US
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Telephone | 765-449-9117
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 39000389A
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License Number State | IN
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