Healthcare Provider Details

I. General information

NPI: 1700366416
Provider Name (Legal Business Name): CHANTELLE MASSIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 SHARON WOODS BLVD
COLUMBUS OH
43229-2600
US

IV. Provider business mailing address

5900 SHARON WOODS BLVD
COLUMBUS OH
43229-2600
US

V. Phone/Fax

Practice location:
  • Phone: 614-895-6818
  • Fax:
Mailing address:
  • Phone: 614-895-6818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2405907-TRNE
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: