Provider Demographics
NPI:1841557584
Name:CREECH, NATHAN (BCABA, LABA)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:CREECH
Suffix:
Gender:M
Credentials:BCABA, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 ALUM SPRING RD STE 202
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-8011
Mailing Address - Country:US
Mailing Address - Phone:800-686-5614
Mailing Address - Fax:
Practice Address - Street 1:1329 ALUM SPRING RD STE 202
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8011
Practice Address - Country:US
Practice Address - Phone:540-693-0380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
VA0134000117103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst