Provider Demographics
NPI:1891035168
Name:SMITLEY, CHRISTOPHER J (LISW-S)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:SMITLEY
Suffix:
Gender:M
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 GRUBB RD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-8659
Mailing Address - Country:US
Mailing Address - Phone:740-773-4261
Mailing Address - Fax:
Practice Address - Street 1:5310 E MAIN ST
Practice Address - Street 2:102
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2598
Practice Address - Country:US
Practice Address - Phone:614-751-1090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00041181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI0004118OtherLICENSE