Provider Demographics
NPI:1548716145
Name:LITTLE CREEK OUTPATIENT SERVICES LLC
Entity type:Organization
Organization Name:LITTLE CREEK OUTPATIENT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENDRY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, CCS
Authorized Official - Phone:570-689-2043
Mailing Address - Street 1:PO BOX 942
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:PA
Mailing Address - Zip Code:18427-0942
Mailing Address - Country:US
Mailing Address - Phone:570-689-6068
Mailing Address - Fax:570-689-2744
Practice Address - Street 1:473 EASTON TPKE STE 5
Practice Address - Street 2:
Practice Address - City:LAKE ARIEL
Practice Address - State:PA
Practice Address - Zip Code:18436-4716
Practice Address - Country:US
Practice Address - Phone:570-689-6068
Practice Address - Fax:570-689-2744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA647021261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center