CREEKSIDE COUNSELING CENTER, LLC (NPI# 1922126168) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922126168 |
| Entity Type | Organization |
| Organization Name | CREEKSIDE COUNSELING CENTER, LLC |
| Practice Address |
106 S Broad St Canfield OH 44406-1447 |
| Practice Telephone | 3305335450 |
| Practice Fax Number | 3305334292 |
| Mailing Telephone | 3305335450 |
| Mailing Fax Number | 3305334292 |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. THOMAS RICHARD KUPEC (CHIEF EXCUTIVE MANAGER) |
| Authorized Official Telephone | 3305335450 |
| Authorized Official Credential | MSED |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
E-0003444-SUPV | OH | Behavioral Health & Social Service Providers |
| Street Address |
106 S BROAD ST |
| City | CANFIELD |
| State | OH |
| Zip Code | 44406-1447 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225168149 | Anne Lally | Counselor | 106 S Broad St, Canfield, OH 44406-1447 | 2007-03-07 |
| 1518192608 | Creekside Counseling Center LLC | Counselor | 106 S Broad St, Canfield, OH 44406-1447 | 2009-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952802282 | Julie Nicole Austalosh | Case Manager/Care Coordinator | 3711 Indian Run Dr Apt 7, Canfield, OH 44406 | 2018-02-22 |
| 1073064887 | Abby Smith | Specialist/Technologist | 250 Lake Pointe Circle, Canfield, OH 44406 | 2016-10-17 |
| 1255887949 | Chris Smallwood II | Driver | 6128 St Andrews Dr, Canfield, OH 44406 | 2016-09-01 |
| 1831572064 | Gateways To Better Living | Intermediate Care Facility, Mentally Retarded | 41 Talsman Drive, Youngstown, OH 44406 | 2015-07-07 |
| 1568845790 | Gateways To Better Living | Intermediate Care Facility, Mentally Retarded | 3222 Forty Second Street, Youngstown, OH 44406 | 2015-07-07 |
| 1003212051 | Diane Pool | Registered Nurse | 100 Wadsworth Street, Canfield, OH 44406 | 2014-11-18 |
| 1215353990 | Jeanne Siverd | Occupational Therapy Assistant | 11300 Columbiana-canfield Rd., Suite E, Canfield, OH 44406 | 2014-03-05 |
| 1134565641 | Dema Halasa Esper | Dietitian, Registered | 52 Timber Run Dr., Canfield, OH 44406 | 2013-05-13 |
| 1851680615 | Kimberly Jean Fyock | Licensed Practical Nurse | 7720 Lydia Ln, Canfield, OH 44406 | 2011-04-01 |
| 1205060654 | Jennifer L Morris | Registered Nurse | 3787 Mercedes Place, Canfield, OH 44406 | 2009-05-13 |
| Find all providers in zip 44406 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497378194 | Adelle Rae Madison | Counselor | 7105 Herbert Rd, Canfield, OH 44406-8660 | 2020-05-28 |
| 1386025807 | Kimberly King | Counselor | 3620 Stutz Dr, Canfield, OH 44406-9176 | 2015-06-10 |
| 1073949640 | Meredith Leigh Edgar-bailey | Counselor | 4030 Boardman Canfield Rd Ste 200c, Canfield, OH 44406-8062 | 2013-09-16 |
| 1225168149 | Anne Lally | Counselor | 106 S Broad St, Canfield, OH 44406-1447 | 2007-03-07 |
| 1457320889 | Thomas Richard Kupec | Counselor | 132 S Broad St Ste 203, Canfield, OH 44406-1437 | 2006-03-16 |
| 1336126341 | John J Allan | Counselor | 3974 Boardman Canfield Rd, Canfield, OH 44406-9043 | 2005-12-30 |
| 1073178604 | Teonna Michelle Richardson | Counselor | 3620 Stutz Dr, Canfield, OH 44406-9176 | 2019-05-09 |
| 1134484348 | Katherine Feather | Counselor | 4030 Boardman Canfield Rd, Suite 200c, Canfield, OH 44406-9505 | 2012-07-13 |
| 1518192608 | Creekside Counseling Center LLC | Counselor | 106 S Broad St, Canfield, OH 44406-1447 | 2009-05-19 |
| 1063536548 | Canfield Counseling Clinic, Inc | Counselor | 3974 Boardman Canfield Rd, Canfield, OH 44406-9043 | 2007-03-19 |
| Find all providers in CANFIELD | ||||
Please comment or provide details below to improve the information on CREEKSIDE COUNSELING CENTER, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.