Provider Demographics
NPI:1477088938
Name:CREEKSIDE THERAPY SERVICES
Entity Type:Organization
Organization Name:CREEKSIDE THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:620-200-0234
Mailing Address - Street 1:1531 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-2613
Mailing Address - Country:US
Mailing Address - Phone:620-200-0234
Mailing Address - Fax:
Practice Address - Street 1:1531 WILLOW RD
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-2613
Practice Address - Country:US
Practice Address - Phone:620-200-0234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-21
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS39291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty