Provider Demographics
NPI:1124369475
Name:COBLENTZ, CHRISTIAN R (MSW LSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIAN
Middle Name:R
Last Name:COBLENTZ
Suffix:
Gender:F
Credentials:MSW LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-1913
Mailing Address - Country:US
Mailing Address - Phone:937-492-6971
Mailing Address - Fax:
Practice Address - Street 1:1101 N VANDEMARK RD
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-3567
Practice Address - Country:US
Practice Address - Phone:937-492-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1200403104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker