Healthcare Provider Details

I. General information

NPI: 1992014278
Provider Name (Legal Business Name): CREER COUNSELING CONCEPTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 W SAINT PETER AVE
SAN DIEGO TX
78384-3049
US

IV. Provider business mailing address

PO BOX 684
SAN DIEGO TX
78384-0684
US

V. Phone/Fax

Practice location:
  • Phone: 361-389-1678
  • Fax:
Mailing address:
  • Phone: 361-389-1678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number16111
License Number StateTX

VIII. Authorized Official

Name: ALISSA IDETTE GARCIA
Title or Position: DIRECTOR
Credential: LCDC
Phone: 361-389-1678