Healthcare Provider Details

I. General information

NPI: 1740764521
Provider Name (Legal Business Name): CHELSEA NICOLE LEMONTE MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEA NICOLE PETERS

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1558 E BOULEVARD STE A
KOKOMO IN
46902-2479
US

IV. Provider business mailing address

3500 DEPAUW BLVD STE 3070
INDIANAPOLIS IN
46268-6135
US

V. Phone/Fax

Practice location:
  • Phone: 317-939-5377
  • Fax: 317-520-8200
Mailing address:
  • Phone: 855-324-0885
  • Fax: 317-520-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-36144
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: