Provider Demographics
NPI:1821695149
Name:CHRISSY SMITH LCSW LLC
Entity Type:Organization
Organization Name:CHRISSY SMITH LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISSY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:309-369-1537
Mailing Address - Street 1:5836 N ANDOVER CT
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-2810
Mailing Address - Country:US
Mailing Address - Phone:309-369-1537
Mailing Address - Fax:
Practice Address - Street 1:3526 N CALIFORNIA AVE STE 101
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-1143
Practice Address - Country:US
Practice Address - Phone:309-431-2411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health