Provider Demographics
NPI:1871030155
Name:MENDENHALL, CHRISTAL (LISW)
Entity Type:Individual
Prefix:
First Name:CHRISTAL
Middle Name:
Last Name:MENDENHALL
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 PARK MEADOW RD STE H
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-2876
Mailing Address - Country:US
Mailing Address - Phone:614-357-7183
Mailing Address - Fax:855-740-2025
Practice Address - Street 1:623 PARK MEADOW RD STE H
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2876
Practice Address - Country:US
Practice Address - Phone:614-357-7183
Practice Address - Fax:855-740-2025
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.12000471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0290876Medicaid