MEDICARE: STEPHANIE TISDEL CRESWELL MA, LMHC, CMHS, MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LH00011048	WA

General Provider Information

NPI Number	:	1740461094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE TISDEL CRESWELL MA, LMHC, CMHS, MPH

Provider Business Mailing Address
First Line	:	100 23RD AVE S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98144-2302
Country	:	US
Telephone Number	:	206-328-6841
Fax Number	:	206-328-5909

Provider Business Practice Location Address
First Line	:	6020 77TH AVE SE
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-4818
Country	:	US
Telephone Number	:	206-972-6921
Fax Number	:	206-328-5909

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	11/15/2007

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