Provider Demographics
NPI:1861239899
Name:SPRING CREEK EMDR LLC
Entity type:Organization
Organization Name:SPRING CREEK EMDR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKEON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LAC
Authorized Official - Phone:970-759-7095
Mailing Address - Street 1:2519 S SHIELDS ST
Mailing Address - Street 2:STE 1K PMB 1093
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526
Mailing Address - Country:US
Mailing Address - Phone:970-759-7095
Mailing Address - Fax:970-360-3543
Practice Address - Street 1:2444 RIDGE TOP DRIVE
Practice Address - Street 2:UNIT 1
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526
Practice Address - Country:US
Practice Address - Phone:970-759-7095
Practice Address - Fax:970-360-3543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty