Provider Demographics
NPI:1619174950
Name:CREIGHTON-CLAVEL, SUSAN L (LMFT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:L
Last Name:CREIGHTON-CLAVEL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:SUZAN
Other - Middle Name:
Other - Last Name:CREIGHTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SAME
Mailing Address - Street 1:5740 WINDMILL WAY STE 11
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-1379
Mailing Address - Country:US
Mailing Address - Phone:916-296-1255
Mailing Address - Fax:916-283-6665
Practice Address - Street 1:5740 WINDMILL WAY STE 11
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-1379
Practice Address - Country:US
Practice Address - Phone:916-296-1255
Practice Address - Fax:916-283-6665
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30763106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA03400PSUMFT30763012OtherBLUE SHIELD PROVIDER