Provider Demographics
NPI:1386023414
Name:CREIGHTON, XAN
Entity Type:Individual
Prefix:
First Name:XAN
Middle Name:
Last Name:CREIGHTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 S 15TH ST
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-2696
Mailing Address - Country:US
Mailing Address - Phone:406-812-0688
Mailing Address - Fax:
Practice Address - Street 1:1007 S 15TH ST
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-2696
Practice Address - Country:US
Practice Address - Phone:406-812-0688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health