Provider Demographics
NPI:1114524501
Name:KHOURY, CHANDLER HOLDREN (MASTERS)
Entity Type:Individual
Prefix:MRS
First Name:CHANDLER
Middle Name:HOLDREN
Last Name:KHOURY
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:MISS
Other - First Name:CHANDLER
Other - Middle Name:HERRON
Other - Last Name:HOLDREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BACHELORS
Mailing Address - Street 1:7413 SQUIRE CT
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-2313
Mailing Address - Country:US
Mailing Address - Phone:513-847-4685
Mailing Address - Fax:513-847-4763
Practice Address - Street 1:7413 SQUIRE CT
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-2313
Practice Address - Country:US
Practice Address - Phone:513-847-4685
Practice Address - Fax:513-847-4763
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0005845Medicaid