Provider Demographics
NPI:1275969693
Name:HOLBERT, CHELSEA B (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHELSEA
Middle Name:B
Last Name:HOLBERT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:THE 1503 N MITTHOEFFER ROAD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229
Mailing Address - Country:US
Mailing Address - Phone:765-400-2136
Mailing Address - Fax:
Practice Address - Street 1:1210 MEDICAL ARTS BLVD STE 300B
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3439
Practice Address - Country:US
Practice Address - Phone:765-400-2140
Practice Address - Fax:765-400-2165
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN20043304A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program