Provider Demographics
NPI:1982132403
Name:CREEL, KRISTIN
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:CREEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 897
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83701-0897
Mailing Address - Country:US
Mailing Address - Phone:208-367-9021
Mailing Address - Fax:
Practice Address - Street 1:3050 E DESERT INN RD STE 116
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3872
Practice Address - Country:US
Practice Address - Phone:702-796-0660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV00125-LCSOtherSUPERVISOR OF LICENSE CLINICAL ALCOHOL & DRUG COUNSELORS
NV306-LCOtherLICENSED CLINICAL ALCOHOL AND DRUG COUNSELOR