Provider Demographics
NPI:1265004386
Name:FLICK, CHANTAL (BCBA, MA)
Entity Type:Individual
Prefix:MRS
First Name:CHANTAL
Middle Name:
Last Name:FLICK
Suffix:
Gender:F
Credentials:BCBA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 W 37TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46013-4004
Mailing Address - Country:US
Mailing Address - Phone:765-631-3868
Mailing Address - Fax:888-616-1634
Practice Address - Street 1:550 W 37TH ST STE A
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-4004
Practice Address - Country:US
Practice Address - Phone:765-631-3868
Practice Address - Fax:888-616-1634
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN968129103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst