Provider Demographics
NPI:1376657015
Name:STAMM, CHRISTOPHER L (MBA,MSW,LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:L
Last Name:STAMM
Suffix:
Gender:M
Credentials:MBA,MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 443
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47390-0443
Mailing Address - Country:US
Mailing Address - Phone:765-584-7409
Mailing Address - Fax:765-584-1908
Practice Address - Street 1:501 N HOWARD ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:IN
Practice Address - Zip Code:47390-1118
Practice Address - Country:US
Practice Address - Phone:765-546-9143
Practice Address - Fax:765-964-4300
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005064A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN252010AMedicare PIN
INM400019818Medicare PIN