Healthcare Provider Details

I. General information

NPI: 1689148041
Provider Name (Legal Business Name): CREASON COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5511 E 82ND ST STE K
INDIANAPOLIS IN
46250-4515
US

IV. Provider business mailing address

5511 E 82ND ST STE K
INDIANAPOLIS IN
46250-4515
US

V. Phone/Fax

Practice location:
  • Phone: 317-721-9585
  • Fax:
Mailing address:
  • Phone: 317-721-9585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATE CREASON
Title or Position: OWNER
Credential: MSW, LCSW
Phone: 317-721-9585