MEDICARE: NATALLIE SHAMPELLE CHIVERS LOCKHART

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	5473	MN

General Provider Information

NPI Number	:	1649125055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALLIE SHAMPELLE CHIVERS LOCKHART

Provider Business Mailing Address
First Line	:	5401 BRYANT AVE N
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55430-3114
Country	:	US
Telephone Number	:	612-644-1841
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 2ND ST NE STE 126
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-1139
Country	:	US
Telephone Number	:	612-259-7384
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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