MEDICARE: BETHANY ANNE CHATELAIN

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1164276705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY ANNE CHATELAIN

Provider Business Mailing Address
First Line	:	4040 S MERIDIAN ST STE 17
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46217-3310
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4040 S MERIDIAN ST STE 17
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46217-3310
Country	:	US
Telephone Number	:	317-460-4812
Fax Number	:

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

Provider Enumeration Date	:	04/11/2024
Last Update Date	:	04/11/2024

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Directions to “ BETHANY ANNE CHATELAIN ” Practice Location

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