Provider Demographics
NPI:1710418843
Name:CHARTER, JENELLE B (LPCC)
Entity type:Individual
Prefix:
First Name:JENELLE
Middle Name:B
Last Name:CHARTER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3929 ROCKY RIVER DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-4153
Mailing Address - Country:US
Mailing Address - Phone:216-252-5800
Mailing Address - Fax:216-252-9055
Practice Address - Street 1:3929 ROCKY RIVER DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-4153
Practice Address - Country:US
Practice Address - Phone:216-252-5800
Practice Address - Fax:216-252-9055
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2202754101YM0800X, 101YP2500X
OHC1500353101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE.2202754OtherPROFESSIONAL LICENSE