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General NPI Number Information
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NPI Number | 1700665445
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Entity Type | Organization
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Legal Business Name | CREIGHTON OAKS TREATMENT SERVICES MANAGEMENT, LLC
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Dates
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Enumeration Date | 09/22/2023
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Last Update Date | 09/22/2023
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Provider Practice Location Address
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Address Line | 11313 LONG DR
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City | CONROE
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State | TX
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Zip | 77302
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Country | US
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Telephone | 713-384-3908
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Fax |
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Provider Business Mailing Address
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Address Line | 697 EDGEWOOD DR
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City | MONTGOMERY
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State | TX
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Zip | 77356-8431
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Country | US
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Telephone | 713-384-3908
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KONSTANTIN SAVVON
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Credential |
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Telephone | 713-384-3908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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