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NPI Code Detail

MEDICARE: TINA R CREIGHTON LPC

MEDICARE: TINA R CREIGHTON 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
1101YP2500XProfessional CounselorC1300218OH

General Provider Information

NPI Number : 1740622083
Entity Type Code : Individual
Provider Name (Legal Business Name) : TINA R CREIGHTON LPC
Provider Business Mailing Address
First Line : PO BOX 609
Second Line :
City : ELIZABETH
State : WV
Zip : 26143-0609
Country : US
Telephone Number : 304-275-3301
Fax Number : 304-275-4798
Provider Business Practice Location Address
First Line : 3705 EMERSON AVE
Second Line :
City : PARKERSBURG
State : WV
Zip : 26104-1118
Country : US
Telephone Number : 304-917-3530
Fax Number : 304-917-3743
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2013
Last Update Date : 11/19/2024

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