Provider Demographics
NPI:1598014292
Name:CREASY, BRIAN AUGUST (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:AUGUST
Last Name:CREASY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-8808
Mailing Address - Country:US
Mailing Address - Phone:304-596-5780
Mailing Address - Fax:304-596-5871
Practice Address - Street 1:2004 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-8808
Practice Address - Country:US
Practice Address - Phone:304-596-5780
Practice Address - Fax:304-596-5871
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36616103TC0700X
WV1123103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810030132Medicaid
WVQ51477B987Medicare PIN