Provider Demographics
NPI:1083707335
Name:MODRALL, CHRIS H (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:H
Last Name:MODRALL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18667
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45018-0667
Mailing Address - Country:US
Mailing Address - Phone:513-269-4218
Mailing Address - Fax:513-829-2830
Practice Address - Street 1:1248 NILLES RD
Practice Address - Street 2:SUITE 8
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-2762
Practice Address - Country:US
Practice Address - Phone:513-269-4218
Practice Address - Fax:513-829-2830
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4482103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist