Provider Demographics
NPI:1902996192
Name:SMITH, CHAYZEE (MS, LMHC, LCAC)
Entity Type:Individual
Prefix:MR
First Name:CHAYZEE
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:MS, LMHC, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47375-0487
Mailing Address - Country:US
Mailing Address - Phone:765-983-8000
Mailing Address - Fax:765-983-8609
Practice Address - Street 1:2345 S LYNHURST DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-8630
Practice Address - Country:US
Practice Address - Phone:317-247-8900
Practice Address - Fax:317-272-0807
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001721A101YM0800X
IN87001182A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)