Healthcare Provider Details

I. General information

NPI: 1811814726
Provider Name (Legal Business Name): CHANCELOR CLINE MSN APRN PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4368 DRESSLER RD NW STE 103
CANTON OH
44718-2776
US

IV. Provider business mailing address

4368 DRESSLER RD NW STE 103
CANTON OH
44718-2776
US

V. Phone/Fax

Practice location:
  • Phone: 330-433-1300
  • Fax: 330-494-0828
Mailing address:
  • Phone: 330-433-1300
  • Fax: 330-494-0828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0042595
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: