Provider Demographics
NPI:1225678238
Name:HASTY, CHEYANNE LARAE (RBT)
Entity type:Individual
Prefix:
First Name:CHEYANNE
Middle Name:LARAE
Last Name:HASTY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:317-449-2104
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:801 CONGRESSIONAL BLVD STE 600
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5648
Practice Address - Country:US
Practice Address - Phone:317-689-7850
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
IN1-24-76720103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician