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General NPI Number Information
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NPI Number | 1720372592
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Entity Type | Organization
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Legal Business Name | DREAMING CREEK LLC
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Dates
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Enumeration Date | 06/08/2011
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Last Update Date | 06/08/2011
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Provider Practice Location Address
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Address Line | 1610 W GLENDALE AVE
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City | PHOENIX
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State | AZ
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Zip | 85021-8948
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Country | US
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Telephone | 602-309-0403
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Fax |
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Provider Business Mailing Address
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Address Line | 15390 W PINCHOT CT
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City | GOODYEAR
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State | AZ
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Zip | 85395-8897
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Country | US
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Telephone | 602-309-0403
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | CATHERINE C. LINDSTROM
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Credential | PHD
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Telephone | 602-309-0403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1748
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License Number State | AZ
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