Healthcare Provider Details

I. General information

NPI: 1982924494
Provider Name (Legal Business Name): JESSICA CREASY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 06/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 FLORAL AVE STE 30
CHICO CA
95973-9143
US

IV. Provider business mailing address

2550 FLORAL AVE
CHICO CA
95973-9143
US

V. Phone/Fax

Practice location:
  • Phone: 530-893-4784
  • Fax: 530-893-6144
Mailing address:
  • Phone: 530-893-4784
  • Fax: 530-893-6144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: