Provider Demographics
NPI:1649030990
Name:OWL CREEK COUNSELING LLC
Entity type:Organization
Organization Name:OWL CREEK COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKLEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-255-9538
Mailing Address - Street 1:3819 E WEYBURN RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-2037
Mailing Address - Country:US
Mailing Address - Phone:607-262-0458
Mailing Address - Fax:
Practice Address - Street 1:9023 FOREST HILL AVE STE 2A
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-3054
Practice Address - Country:US
Practice Address - Phone:804-255-9341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty