1023747318 NPI number — EDWARD RICHELY CREECH M.ED., LPC 070101074

Table of content: EDWARD RICHELY CREECH M.ED., LPC 070101074 (NPI 1023747318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023747318 NPI number — EDWARD RICHELY CREECH M.ED., LPC 070101074

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CREECH
Provider First Name:
EDWARD
Provider Middle Name:
RICHELY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED., LPC 070101074
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023747318
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 19
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARTRIDGE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40862-0019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-733-0614
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PC 310 CLOVERLEAF SQUARE
Provider Second Line Business Practice Location Address:
STE B2
Provider Business Practice Location Address City Name:
BIGSTONE GAP
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-409-5055
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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