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General NPI Number Information
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NPI Number | 1740461094
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Entity Type | Individual
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Provider Name | STEPHANIE TISDEL CRESWELL MA, LMHC, CMHS, MPH
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Gender | Female
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 6020 77TH AVE SE
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City | MERCER ISLAND
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State | WA
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Zip | 98040-4818
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Country | US
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Telephone | 206-972-6921
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Fax | 206-328-5909
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Provider Business Mailing Address
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Address Line | 100 23RD AVE S
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City | SEATTLE
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State | WA
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Zip | 98144-2302
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Country | US
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Telephone | 206-328-6841
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Fax | 206-328-5909
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH00011048
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License Number State | WA
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