Provider Demographics
NPI:1073818662
Name:CHRIS CHECKETT LLC
Entity Type:Organization
Organization Name:CHRIS CHECKETT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:TERENCE
Authorized Official - Last Name:CHECKETT
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:440-331-5570
Mailing Address - Street 1:20325 CENTER RIDGE RD
Mailing Address - Street 2:SUITE 628
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3572
Mailing Address - Country:US
Mailing Address - Phone:440-331-5570
Mailing Address - Fax:440-331-3221
Practice Address - Street 1:20325 CENTER RIDGE RD
Practice Address - Street 2:SUITE 628
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3572
Practice Address - Country:US
Practice Address - Phone:440-331-5570
Practice Address - Fax:440-331-3221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI. 0800032 SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty