MEDICARE: LISA ANN CLINE-CREEL MA, LPC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	1770	WV

General Provider Information

NPI Number	:	1568612562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ANN CLINE-CREEL MA, LPC

Provider Business Mailing Address
First Line	:	1207 JEFFERSON RD
Second Line	:
City	:	SOUTH CHARLESTON
State	:	WV
Zip	:	25309-9732
Country	:	US
Telephone Number	:	304-205-5071
Fax Number	:	304-205-5138

Provider Business Practice Location Address
First Line	:	1207 JEFFERSON RD
Second Line	:
City	:	SOUTH CHARLESTON
State	:	WV
Zip	:	25309-9732
Country	:	US
Telephone Number	:	304-205-5071
Fax Number	:	304-205-5138

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2008
Last Update Date	:	09/25/2008

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