Provider Demographics
NPI:1538511712
Name:CREECH, KATHLEEN MAE
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MAE
Last Name:CREECH
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 1:536 MIDWAY CHURCH LN
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:LA
Mailing Address - Zip Code:71232-9098
Mailing Address - Country:US
Mailing Address - Phone:318-401-4415
Mailing Address - Fax:318-728-7222
Practice Address - Street 1:536 MIDWAY CHURCH LN
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:LA
Practice Address - Zip Code:71232-9098
Practice Address - Country:US
Practice Address - Phone:318-401-4415
Practice Address - Fax:318-728-7222
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health