Provider Demographics
NPI:1902129141
Name:CREEK, SHIRLEY KALANA (MS, LCPC)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:KALANA
Last Name:CREEK
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 S EWING ST STE 507
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-5732
Mailing Address - Country:US
Mailing Address - Phone:406-459-0756
Mailing Address - Fax:406-545-3940
Practice Address - Street 1:25 S EWING ST STE 507
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-5732
Practice Address - Country:US
Practice Address - Phone:406-459-0756
Practice Address - Fax:406-545-3940
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1016101YA0400X
NE3877101YM0800X
NE927101YM0800X
MTBBH-LCPC-LIC-9676101YP2500X
NE1920101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1154644318Medicaid
NE10025852400Medicaid