Provider Demographics
NPI:1336516053
Name:BOX, LECHRISTIEN RENEE (MA)
Entity Type:Individual
Prefix:MRS
First Name:LECHRISTIEN
Middle Name:RENEE
Last Name:BOX
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 BROADWAY
Mailing Address - Street 2:STE. 104
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46402-2414
Mailing Address - Country:US
Mailing Address - Phone:219-882-4010
Mailing Address - Fax:219-882-0210
Practice Address - Street 1:839 BROADWAY
Practice Address - Street 2:STE. 104
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46402-2414
Practice Address - Country:US
Practice Address - Phone:219-882-4010
Practice Address - Fax:219-882-0210
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN193200000X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201241590AMedicaid