Provider Demographics
NPI:1720244783
Name:MAXWELL, CHRISTINA ELIZABETH (PSYD, HSPP)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:ELIZABETH
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:PSYD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6337 HOLLISTER DR STE 101
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-2996
Mailing Address - Country:US
Mailing Address - Phone:317-682-9279
Mailing Address - Fax:
Practice Address - Street 1:6337 HOLLISTER DR STE 101
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-2996
Practice Address - Country:US
Practice Address - Phone:317-682-9279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043040A103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20043040AOtherPSYD LICENSE