MEDICARE: CHAVA KRISTIN MOLCHAN

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	101YP2500X	Professional Counselor	39005508A	IN
2	101YP2500X	Professional Counselor	2606	WV

General Provider Information

NPI Number	:	1316613805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAVA KRISTIN MOLCHAN

Provider Business Mailing Address
First Line	:	2803 BOILERMAKER CT STE 1C
Second Line	:
City	:	VALPARAISO
State	:	IN
Zip	:	46383-8412
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2803 BOILERMAKER CT STE 1C
Second Line	:
City	:	VALPARAISO
State	:	IN
Zip	:	46383-8412
Country	:	US
Telephone Number	:	304-382-5228
Fax Number	:

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

Provider Enumeration Date	:	08/17/2021
Last Update Date	:	05/13/2026

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