Provider Demographics
NPI:1144075615
Name:CROOKED CREEK MENTAL HEALTH, LLC
Entity type:Organization
Organization Name:CROOKED CREEK MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NP
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADER
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:575-361-5646
Mailing Address - Street 1:13818 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:CUMMINGS
Mailing Address - State:KS
Mailing Address - Zip Code:66016-9186
Mailing Address - Country:US
Mailing Address - Phone:575-361-5646
Mailing Address - Fax:
Practice Address - Street 1:513 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-2418
Practice Address - Country:US
Practice Address - Phone:575-361-5646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty