Provider Demographics
NPI:1902252141
Name:EDLIN, CHRISTOPHER (LMHCA)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:EDLIN
Suffix:
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VEVAY
Mailing Address - State:IN
Mailing Address - Zip Code:47043-9192
Mailing Address - Country:US
Mailing Address - Phone:812-427-2737
Mailing Address - Fax:
Practice Address - Street 1:1037 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VEVAY
Practice Address - State:IN
Practice Address - Zip Code:47043-9192
Practice Address - Country:US
Practice Address - Phone:812-427-2737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88000087A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health