Provider Demographics
NPI:1861150021
Name:CREATH COUNSELING
Entity type:Organization
Organization Name:CREATH COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:CREATH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:314-270-2161
Mailing Address - Street 1:2318 WOODSON RD UNIT 140064
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-7002
Mailing Address - Country:US
Mailing Address - Phone:314-270-2161
Mailing Address - Fax:
Practice Address - Street 1:10000 TAM O SHANTER DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-1532
Practice Address - Country:US
Practice Address - Phone:314-270-2161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty