Provider Demographics
NPI:1912966128
Name:CREEL, SUZANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:CREEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 W HALE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8439
Mailing Address - Country:US
Mailing Address - Phone:337-433-9177
Mailing Address - Fax:337-433-9173
Practice Address - Street 1:2829 4TH AVE
Practice Address - Street 2:150
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7887
Practice Address - Country:US
Practice Address - Phone:337-477-7091
Practice Address - Fax:337-474-4552
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA43681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4B479Medicare ID - Type Unspecified