Provider Demographics
NPI:1154838902
Name:CREELY, JAMES EDWARD COLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD COLE
Last Name:CREELY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 CARLTON AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-2955
Mailing Address - Country:US
Mailing Address - Phone:626-235-8016
Mailing Address - Fax:
Practice Address - Street 1:520 S GRAND AVE STE 671
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90071-2655
Practice Address - Country:US
Practice Address - Phone:626-219-3736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29764103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist