Healthcare Provider Details

I. General information

NPI: 1902996192
Provider Name (Legal Business Name): CHAYZEE SMITH MS, LMHC, LCAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 S LYNHURST DR
INDIANAPOLIS IN
46241-8630
US

IV. Provider business mailing address

PO BOX 487
RICHMOND IN
47375-0487
US

V. Phone/Fax

Practice location:
  • Phone: 317-247-8900
  • Fax: 317-272-0807
Mailing address:
  • Phone: 765-983-8000
  • Fax: 765-983-8609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39001721A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87001182A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: