Provider Demographics
NPI:1588678262
Name:PICHOLA, KATHLEEN (PHD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:PICHOLA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4424
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-0424
Mailing Address - Country:US
Mailing Address - Phone:330-665-5042
Mailing Address - Fax:330-665-5042
Practice Address - Street 1:3200 W MARKET ST
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3335
Practice Address - Country:US
Practice Address - Phone:330-665-5042
Practice Address - Fax:330-665-5042
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3949103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical