Provider Demographics
NPI:1679849699
Name:CREECH, CHARITY ELAINE
Entity Type:Individual
Prefix:MRS
First Name:CHARITY
Middle Name:ELAINE
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 1:500 SW BOND ST
Mailing Address - Street 2:SUITE 179
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1573
Mailing Address - Country:US
Mailing Address - Phone:541-241-6097
Mailing Address - Fax:
Practice Address - Street 1:500 SW BOND ST
Practice Address - Street 2:SUITE 179
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1573
Practice Address - Country:US
Practice Address - Phone:541-241-6097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR2292101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health