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General NPI Number Information
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NPI Number | 1477088938
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Entity Type | Organization
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Legal Business Name | CREEKSIDE THERAPY SERVICES
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Dates
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Enumeration Date | 04/21/2017
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Last Update Date | 05/10/2017
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Provider Practice Location Address
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Address Line | 1531 WILLOW RD
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City | HUTCHINSON
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State | KS
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Zip | 67502-2613
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Country | US
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Telephone | 620-200-0234
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Fax |
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Provider Business Mailing Address
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Address Line | 1531 WILLOW RD
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City | HUTCHINSON
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State | KS
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Zip | 67502-2613
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Country | US
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Telephone | 620-200-0234
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Fax |
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Authorized Official
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Title or Position | SOLE MBR
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Name | TAMARA S. MADDEN
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Credential | LSCSW
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Telephone | 620-200-0234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3929
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License Number State | KS
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