Healthcare Provider Details

I. General information

NPI: 1316613805
Provider Name (Legal Business Name): CHAVA KRISTIN MOLCHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2803 BOILERMAKER CT STE 1C
VALPARAISO IN
46383-8412
US

IV. Provider business mailing address

2803 BOILERMAKER CT STE 1C
VALPARAISO IN
46383-8412
US

V. Phone/Fax

Practice location:
  • Phone: 304-382-5228
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number39005508A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2606
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: