Provider Demographics
NPI:1700837564
Name:CREECH, KELLY FERRIS (LCSW, LISW-S, LICDC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:FERRIS
Last Name:CREECH
Suffix:
Gender:F
Credentials:LCSW, LISW-S, LICDC
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:JEAN
Other - Last Name:FERRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:19885 DETROIT RD # 190
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-1815
Mailing Address - Country:US
Mailing Address - Phone:033-208-4825
Mailing Address - Fax:
Practice Address - Street 1:20545 CENTER RIDGE RD STE 448
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3423
Practice Address - Country:US
Practice Address - Phone:440-356-0083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2023-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL35341041C0700X
OHI0009973-SUPV104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical