Provider Demographics
NPI:1043887128
Name:EARLES, CHRISTEL LEWIS
Entity type:Individual
Prefix:MRS
First Name:CHRISTEL
Middle Name:LEWIS
Last Name:EARLES
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 1:1701 MERCY HEALTH PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-6147
Mailing Address - Country:US
Mailing Address - Phone:513-853-8520
Mailing Address - Fax:
Practice Address - Street 1:1701 MERCY HEALTH PL
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-6147
Practice Address - Country:US
Practice Address - Phone:513-853-8520
Practice Address - Fax:513-442-7695
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904012750101Y00000X, 101YM0800X, 101YP2500X
KY2578701041C0700X
OHI.2203904101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA03201972OtherOTHER
VA03201972OtherCARE FIRST
VA03201972OtherCAREFIRST