Provider Demographics
NPI:1174333603
Name:MUNGER, CHELSEA (MS, SSP, NCSP)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:MUNGER
Suffix:
Gender:F
Credentials:MS, SSP, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50800 CHERRY RD
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-4900
Mailing Address - Country:US
Mailing Address - Phone:574-271-8598
Mailing Address - Fax:
Practice Address - Street 1:50800 CHERRY RD
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-4900
Practice Address - Country:US
Practice Address - Phone:574-271-8598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10302263103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool