Provider Demographics
NPI:1891706164
Name:CREED, SALLY S (LPC)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:S
Last Name:CREED
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 HEYMANN BLVD # 15
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2465
Mailing Address - Country:US
Mailing Address - Phone:337-806-3690
Mailing Address - Fax:337-205-8596
Practice Address - Street 1:322 HEYMANN BLVD
Practice Address - Street 2:SUITE 15
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2465
Practice Address - Country:US
Practice Address - Phone:337-806-3690
Practice Address - Fax:337-205-8596
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11261101YP2500X
LA5636101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0262628-01Medicaid