Basic Information
| Provider Information | |||||||||
| NPI: | 1912966128 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CREEL | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | |||||||||
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| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 324 W HALE ST | ||||||||
| Address2: | |||||||||
| City: | LAKE CHARLES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706018439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3374339177 | ||||||||
| FaxNumber: | 3374339173 | ||||||||
| Practice Location | |||||||||
| Address1: | 2829 4TH AVE | ||||||||
| Address2: | 150 | ||||||||
| City: | LAKE CHARLES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706017887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3374777091 | ||||||||
| FaxNumber: | 3374744552 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 12/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 4368 | LA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.