Provider Demographics
NPI:1780390203
Name:DESAUTELS, CREATION (LMFT)
Entity type:Individual
Prefix:MS
First Name:CREATION
Middle Name:
Last Name:DESAUTELS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-4765
Mailing Address - Country:US
Mailing Address - Phone:406-465-2596
Mailing Address - Fax:
Practice Address - Street 1:300 E MULBERRY ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-4765
Practice Address - Country:US
Practice Address - Phone:406-465-2596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35002278A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist