Provider Demographics
NPI:1730417544
Name:CHEVALIER, MELISSA KAY (MS, BCBA)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:KAY
Last Name:CHEVALIER
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:KAY
Other - Last Name:DOUGHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BOULEVARD
Mailing Address - Street 2:SUITE 3070
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:765-450-6664
Practice Address - Street 1:21 S PARK BLVD
Practice Address - Street 2:SUITE 21
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-8838
Practice Address - Country:US
Practice Address - Phone:317-449-2104
Practice Address - Fax:765-450-6664
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-08-4817OtherBCBA CERTIFICATE