Provider Demographics
NPI:1720748965
Name:CREIGHTON, MARION (MED LPC)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:
Last Name:CREIGHTON
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 DEL MONTE PINES DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77316-1459
Mailing Address - Country:US
Mailing Address - Phone:936-689-1782
Mailing Address - Fax:
Practice Address - Street 1:107 DEL MONTE PINES DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77316-1459
Practice Address - Country:US
Practice Address - Phone:936-689-1782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17228101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty