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General NPI Number Information
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NPI Number | 1801538889
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Entity Type | Individual
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Provider Name | CRYSTAL MARIE SMALLEY LCSW-I, LMSW
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Gender | Female
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Dates
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Enumeration Date | 04/11/2022
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Last Update Date | 08/01/2022
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Provider Practice Location Address
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Address Line | 621 W MADRONE ST
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City | ROSEBURG
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State | OR
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Zip | 97470-3090
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Country | US
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Telephone | 541-672-2691
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Fax |
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Provider Business Mailing Address
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Address Line | 6490 S MCCARRAN BLVD STE B18
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City | RENO
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State | NV
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Zip | 89509-6121
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Country | US
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Telephone | 775-562-4509
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | IC-1940
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 9260-M
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License Number State | NV
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