Provider Demographics
NPI:1417946237
Name:KHOL, CHAREL LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHAREL
Middle Name:LEE
Last Name:KHOL
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 1:3918 CLOCK POINTE TRL
Mailing Address - Street 2:SUITE 104
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-2989
Mailing Address - Country:US
Mailing Address - Phone:216-839-2273
Mailing Address - Fax:216-896-0735
Practice Address - Street 1:6133 ROCKSIDE RD
Practice Address - Street 2:SUITE 207
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2223
Practice Address - Country:US
Practice Address - Phone:216-520-5969
Practice Address - Fax:216-520-5098
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3455103T00000X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH34 1593635OtherTAX ID
OH34 1593635OtherTAX ID
OHCP02371Medicare ID - Type Unspecified