Provider Demographics
NPI:1326566019
Name:CREED, KRISTI A (REG PSY ASST, MSW,)
Entity Type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:A
Last Name:CREED
Suffix:
Gender:F
Credentials:REG PSY ASST, MSW,
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 1161
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-1161
Mailing Address - Country:US
Mailing Address - Phone:424-284-9249
Mailing Address - Fax:
Practice Address - Street 1:103 S FOREST RD
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-4895
Practice Address - Country:US
Practice Address - Phone:209-533-1699
Practice Address - Fax:209-532-7917
Is Sole Proprietor?:No
Enumeration Date:2017-09-02
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA707381041C0700X
CAPSB94025941103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1477887834Medicaid