Provider Demographics
NPI:1427920636
Name:CREOSOTE COUNSELING
Entity type:Organization
Organization Name:CREOSOTE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAU
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:602-531-7111
Mailing Address - Street 1:6868 N 7TH AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-1198
Mailing Address - Country:US
Mailing Address - Phone:602-531-7111
Mailing Address - Fax:
Practice Address - Street 1:6868 N 7TH AVE STE 104
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-1198
Practice Address - Country:US
Practice Address - Phone:602-531-7111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty