Provider Demographics
NPI:1689697690
Name:RICHCREEK, GENA MARIE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:GENA
Middle Name:MARIE
Last Name:RICHCREEK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13182 SUSSEX PL
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-2150
Mailing Address - Country:US
Mailing Address - Phone:714-955-3149
Mailing Address - Fax:
Practice Address - Street 1:1633 E 4TH ST STE 120
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5143
Practice Address - Country:US
Practice Address - Phone:714-955-3149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2018-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 39162106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist