Provider Demographics
NPI:1861143604
Name:DECK, CHRISTIAN KELLER (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:KELLER
Last Name:DECK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5868 E 71ST ST STE E-679
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4075
Mailing Address - Country:US
Mailing Address - Phone:317-721-1336
Mailing Address - Fax:
Practice Address - Street 1:5868 E 71ST ST STE E-679
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4075
Practice Address - Country:US
Practice Address - Phone:317-721-1336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-13
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34009578A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical