Provider Demographics
NPI:1356127492
Name:EARP, CHANDRA ELLEN
Entity type:Individual
Prefix:
First Name:CHANDRA
Middle Name:ELLEN
Last Name:EARP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 VILLAGE PARK DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-6638
Mailing Address - Country:US
Mailing Address - Phone:614-607-1319
Mailing Address - Fax:
Practice Address - Street 1:8715 BIG BEAR AVE
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7754
Practice Address - Country:US
Practice Address - Phone:740-657-4825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21890620103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool