Basic Information
| Provider Information | |||||||||
| NPI: | 1063757250 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CREEKSIDE COUNSELING, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2586 12TH PL SE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033714160 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2586 12TH PL SE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973022536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033714160 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2012 | ||||||||
| LastUpdateDate: | 11/29/2012 | ||||||||
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| AuthorizedOfficialLastName: | CASTILLEJA | ||||||||
| AuthorizedOfficialFirstName: | TONIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CASE MANAGER/ INSURANCE SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 5033714160 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | BS, CADC 1 | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 08-03-04 | OR | Y | Agencies | Community/Behavioral Health |
No ID Information.