Provider Demographics
NPI:1225330897
Name:CREEKSIDE PSYCHIATRIC CENTER PA
Entity Type:Organization
Organization Name:CREEKSIDE PSYCHIATRIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WEEKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-476-0977
Mailing Address - Street 1:5190 BAYOU BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2162
Mailing Address - Country:US
Mailing Address - Phone:850-476-0977
Mailing Address - Fax:850-476-2558
Practice Address - Street 1:5190 BAYOU BLVD STE 6
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2162
Practice Address - Country:US
Practice Address - Phone:850-476-0977
Practice Address - Fax:850-476-2558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty