MEDICARE: MRS. MELISSA KAY CHEVALIER MS, BCBA

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	103K00000X	Behavior Analyst		GA
2	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-08-4817	OTHER		BCBA CERTIFICATE

General Provider Information

NPI Number	:	1730417544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA KAY CHEVALIER MS, BCBA

Provider Business Mailing Address
First Line	:	3500 DEPAUW BOULEVARD
Second Line	:	SUITE 3070
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-6135
Country	:	US
Telephone Number	:	855-324-0885
Fax Number	:	765-450-6664

Provider Business Practice Location Address
First Line	:	21 S PARK BLVD
Second Line	:	SUITE 21
City	:	GREENWOOD
State	:	IN
Zip	:	46143-8838
Country	:	US
Telephone Number	:	317-449-2104
Fax Number	:	765-450-6664

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

Provider Enumeration Date	:	12/07/2009
Last Update Date	:	01/05/2017

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