Provider Demographics
NPI:1932250024
Name:HOCHADEL, KEITH JERED (LPCC-S)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:JERED
Last Name:HOCHADEL
Suffix:
Gender:M
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 TUSCARAWAS ST E
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44707-3152
Mailing Address - Country:US
Mailing Address - Phone:330-205-9515
Mailing Address - Fax:330-754-6253
Practice Address - Street 1:901 TUSCARAWAS ST E
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44707-3152
Practice Address - Country:US
Practice Address - Phone:330-205-9515
Practice Address - Fax:330-754-6253
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0008405 - SUPV101YP2500X, 101YM0800X
OH081232101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0293399Medicaid