Provider Demographics
NPI:1013980028
Name:SMITH, CHRISTINA RENEE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:RENEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 W WOODBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-1064
Mailing Address - Country:US
Mailing Address - Phone:765-273-3224
Mailing Address - Fax:
Practice Address - Street 1:114 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47305-1734
Practice Address - Country:US
Practice Address - Phone:765-273-3224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001514A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN589745000OtherMAGELLAN
IN000000257045OtherANTHEM
IN100205420AMedicaid
IN000000257045OtherANTHEM