Healthcare Provider Details

I. General information

NPI: 1770309650
Provider Name (Legal Business Name): JULIE ELIZABETH CREECH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1692 EL CAMINO REAL
SAN CARLOS CA
94070-5208
US

IV. Provider business mailing address

PO BOX 1329
SAN CARLOS CA
94070-7329
US

V. Phone/Fax

Practice location:
  • Phone: 650-464-3043
  • Fax:
Mailing address:
  • Phone: 650-817-9070
  • Fax: 650-817-9074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: