Provider Demographics
NPI:1578116109
Name:BLACK, CHELSEA CAROLYN (LMHC)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:CAROLYN
Last Name:BLACK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10967 ALLISONVILLE RD STE 240
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2634
Mailing Address - Country:US
Mailing Address - Phone:317-558-0630
Mailing Address - Fax:
Practice Address - Street 1:10967 ALLISONVILLE RD STE 240
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2634
Practice Address - Country:US
Practice Address - Phone:317-558-0630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003581A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health