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General NPI Number Information
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NPI Number | 1427920636
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Entity Type | Organization
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Legal Business Name | CREOSOTE COUNSELING
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Dates
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Enumeration Date | 09/18/2025
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 6868 N 7TH AVE STE 104
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City | PHOENIX
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State | AZ
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Zip | 85013-1198
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Country | US
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Telephone | 602-531-7111
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Fax |
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Provider Business Mailing Address
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Address Line | 6868 N 7TH AVE STE 104
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City | PHOENIX
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State | AZ
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Zip | 85013-1198
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Country | US
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Telephone | 602-531-7111
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | KELLY RAU
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Credential | LMFT
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Telephone | 602-531-7111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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