Provider Demographics
NPI:1932571361
Name:MONTALVO, CHASITY (LCAC, MS)
Entity type:Individual
Prefix:
First Name:CHASITY
Middle Name:
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:LCAC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9820 E 38TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46235-2303
Mailing Address - Country:US
Mailing Address - Phone:317-796-2238
Mailing Address - Fax:
Practice Address - Street 1:9820 E 38TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46235-2303
Practice Address - Country:US
Practice Address - Phone:317-796-2238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000254A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)