MEDICARE: CREED COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	207Q00000X	Family Medicine Physician
4	207R00000X	Internal Medicine Physician
5	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician
6	2084P0800X	Psychiatry Physician
7	251S00000X	Community/Behavioral Health Agency
8	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1518506781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREED COUNSELING LLC

Provider Business Mailing Address
First Line	:	4086 BROADWAY
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-3025
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4086 BROADWAY
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-3025
Country	:	US
Telephone Number	:	740-804-1526
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	CAROLINE REED
Credential	:
Telephone Number	:	740-804-1526

Provider Enumeration Date	:	01/05/2020
Last Update Date	:	01/05/2020

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