Healthcare Provider Details

I. General information

NPI: 1184166191
Provider Name (Legal Business Name): CHRISTELLE BUHOLZER M.ED., M.A., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 MAIN ST
CHARDON OH
44024-1538
US

IV. Provider business mailing address

695 SOUTH ST SUITE 6
CHARDON OH
44024-1474
US

V. Phone/Fax

Practice location:
  • Phone: 440-214-9062
  • Fax:
Mailing address:
  • Phone: 440-286-1553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.1500827
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1800890
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: