Provider Demographics
NPI:1467676783
Name:CREECH, NANCY LOU (MS)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LOU
Last Name:CREECH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 4933
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350
Mailing Address - Country:US
Mailing Address - Phone:209-521-1258
Mailing Address - Fax:209-521-7756
Practice Address - Street 1:3340 TULLY RD
Practice Address - Street 2:E-16
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-0838
Practice Address - Country:US
Practice Address - Phone:209-521-1258
Practice Address - Fax:209-521-7756
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 33454106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist