Provider Demographics
NPI:1346672078
Name:CREEKSIDE COUNSELING, LLC
Entity Type:Organization
Organization Name:CREEKSIDE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DYKES
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, CACII
Authorized Official - Phone:970-641-1286
Mailing Address - Street 1:211 N IOWA ST
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2219
Mailing Address - Country:US
Mailing Address - Phone:970-641-1286
Mailing Address - Fax:970-641-4648
Practice Address - Street 1:211 N IOWA ST
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2219
Practice Address - Country:US
Practice Address - Phone:970-641-1286
Practice Address - Fax:970-641-4648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1417080920OtherINDIVIDUAL NPI