Provider Demographics
NPI:1629326111
Name:EBERHARDT, CHRISTI (BCABA)
Entity Type:Individual
Prefix:
First Name:CHRISTI
Middle Name:
Last Name:EBERHARDT
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-1736
Mailing Address - Country:US
Mailing Address - Phone:330-416-9902
Mailing Address - Fax:
Practice Address - Street 1:4111 APPLERIDGE LN
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44286-9237
Practice Address - Country:US
Practice Address - Phone:330-416-9902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1629326111Medicaid