Provider Demographics
NPI:1144594862
Name:EATON, CHRISTIAN WESLEY (MA)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:WESLEY
Last Name:EATON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:317-939-5377
Mailing Address - Fax:317-932-7880
Practice Address - Street 1:160 PLAINFIELD VILLAGE DR STE 101
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-2782
Practice Address - Country:US
Practice Address - Phone:463-888-0118
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-11-8987103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300021260Medicaid