Provider Demographics
NPI:1346347721
Name:RILEY, CHRISTOPHER ALAN (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ALAN
Last Name:RILEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 VOYAGER WAY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-8033
Mailing Address - Country:US
Mailing Address - Phone:765-572-2230
Mailing Address - Fax:
Practice Address - Street 1:1005 S MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-2784
Practice Address - Country:US
Practice Address - Phone:765-482-7421
Practice Address - Fax:765-482-7462
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001034A106H00000X
IN34003117A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist