Provider Demographics
NPI:1356866701
Name:CEDAR CREEK PSYCHIATRY, LLC
Entity Type:Organization
Organization Name:CEDAR CREEK PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:903-262-8292
Mailing Address - Street 1:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:EUSTACE
Mailing Address - State:TX
Mailing Address - Zip Code:75124-0118
Mailing Address - Country:US
Mailing Address - Phone:903-262-8292
Mailing Address - Fax:903-675-9577
Practice Address - Street 1:700 S PALESTINE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-3325
Practice Address - Country:US
Practice Address - Phone:903-262-8292
Practice Address - Fax:903-675-9577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP100127363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty