MEDICARE: MS. CHRISTINE OTTAVIANO SHESTAK M.S. LMHC

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	39000248A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	345600	OTHER	IN	MANAGED HEALTH NETWORK
2	473559000	OTHER	IN	MAGELLAN
3	000000324156	OTHER	IN	ANTHEM BLUE CROSS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	512125	OTHER	IN	VALUEOPTIONS

General Provider Information

NPI Number	:	1205831104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINE OTTAVIANO SHESTAK M.S. LMHC

Provider Business Mailing Address
First Line	:	PO BOX 205
Second Line	:
City	:	BLUFFTON
State	:	IN
Zip	:	46714-0205
Country	:	US
Telephone Number	:	260-824-0089
Fax Number	:	260-824-4209

Provider Business Practice Location Address
First Line	:	109 N SCOTT ST
Second Line	:
City	:	BLUFFTON
State	:	IN
Zip	:	46714-2004
Country	:	US
Telephone Number	:	260-824-0089
Fax Number	:	260-824-4209

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	01/20/2012

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