Provider Demographics
NPI:1215417910
Name:CHAMBLEE, JONATHAN (MA, MSW)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:CHAMBLEE
Suffix:
Gender:M
Credentials:MA, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 IRONRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-8890
Mailing Address - Country:US
Mailing Address - Phone:317-473-0487
Mailing Address - Fax:
Practice Address - Street 1:5645 E RAYMOND ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-4967
Practice Address - Country:US
Practice Address - Phone:317-505-1230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN99111738A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program