Basic Information
| Provider Information | |||||||||
| NPI: | 1346347721 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RILEY | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 947 VOYAGER WAY | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479098033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7655722230 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1005 S MERIDIAN ST | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460522784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654827421 | ||||||||
| FaxNumber: | 7654827462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 11/05/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 35001034A | IN | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 1041C0700X | 34003117A | IN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.