Provider Demographics
NPI:1679834238
Name:MCCREARY, COLETTE ANGELA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:COLETTE
Middle Name:ANGELA
Last Name:MCCREARY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 SUNNYBANK DR
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-1357
Mailing Address - Country:US
Mailing Address - Phone:818-425-9248
Mailing Address - Fax:
Practice Address - Street 1:3015 GLENDALE BLVD
Practice Address - Street 2:300B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-1832
Practice Address - Country:US
Practice Address - Phone:818-425-9248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50764106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist