Provider Demographics
NPI:1508311242
Name:CRESWELL, LINDA JEAN
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:JEAN
Last Name:CRESWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:CRESWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5578
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37928-0578
Mailing Address - Country:US
Mailing Address - Phone:865-363-9493
Mailing Address - Fax:
Practice Address - Street 1:2210 SUTHERLAND AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-2337
Practice Address - Country:US
Practice Address - Phone:865-329-8897
Practice Address - Fax:865-622-2740
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3492101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health