Provider Demographics
NPI:1316771520
Name:SCEALF, CHASKA
Entity type:Individual
Prefix:
First Name:CHASKA
Middle Name:
Last Name:SCEALF
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 1:1480 WARREN RD APT 410
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3927
Mailing Address - Country:US
Mailing Address - Phone:216-235-0061
Mailing Address - Fax:
Practice Address - Street 1:24500 CENTER RIDGE RD STE 395
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5631
Practice Address - Country:US
Practice Address - Phone:440-455-9125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2405626-TRNE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health