Provider Demographics
NPI:1639856651
Name:CREEKSIDE COUNSELING AND WELLNESS, LLC
Entity Type:Organization
Organization Name:CREEKSIDE COUNSELING AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ULRIKE
Authorized Official - Middle Name:JENNIFER ERIKA
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:740-330-4310
Mailing Address - Street 1:1970 N COUNTY ROAD 605
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:OH
Mailing Address - Zip Code:43074-8981
Mailing Address - Country:US
Mailing Address - Phone:740-330-4310
Mailing Address - Fax:740-330-4330
Practice Address - Street 1:80 S COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:OH
Practice Address - Zip Code:43074-9480
Practice Address - Country:US
Practice Address - Phone:740-330-4310
Practice Address - Fax:740-330-4330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)