Healthcare Provider Details

I. General information

NPI: 1598014292
Provider Name (Legal Business Name): BRIAN AUGUST CREASY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 PROFESSIONAL CT
MARTINSBURG WV
25401-8808
US

IV. Provider business mailing address

2004 PROFESSIONAL CT
MARTINSBURG WV
25401-8808
US

V. Phone/Fax

Practice location:
  • Phone: 304-596-5780
  • Fax: 304-596-5871
Mailing address:
  • Phone: 304-596-5780
  • Fax: 304-596-5871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number36616
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1123
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: