Provider Demographics
NPI:1801368634
Name:SPENCER, CHRIS (OBBC, CDCD, MSW)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:OBBC, CDCD, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3783 MERRYMOUND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-1905
Mailing Address - Country:US
Mailing Address - Phone:216-972-0703
Mailing Address - Fax:
Practice Address - Street 1:27600 CHAGRIN BLVD STE 300
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:OH
Practice Address - Zip Code:44122-4421
Practice Address - Country:US
Practice Address - Phone:216-903-5362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH167362101YA0400X
OH104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker