Healthcare Provider Details

I. General information

NPI: 1891035168
Provider Name (Legal Business Name): CHRISTOPHER J SMITLEY LISW-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2013
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 E MAIN ST 102
COLUMBUS OH
43213-2598
US

IV. Provider business mailing address

1526 GRUBB RD
CHILLICOTHEE OH
45601-8659
US

V. Phone/Fax

Practice location:
  • Phone: 614-751-1090
  • Fax:
Mailing address:
  • Phone: 740-773-4261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0004118
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: