Provider Demographics
NPI:1730200023
Name:CREEKSIDE PSYCHIATRIC CENTER
Entity type:Organization
Organization Name:CREEKSIDE PSYCHIATRIC CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:R
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-476-0977
Mailing Address - Street 1:5190 BAYOU BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2162
Mailing Address - Country:US
Mailing Address - Phone:850-476-0977
Mailing Address - Fax:850-476-2558
Practice Address - Street 1:5190 BAYOU BLVD STE 6
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2162
Practice Address - Country:US
Practice Address - Phone:850-476-0977
Practice Address - Fax:850-476-2558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME26830251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management