Provider Demographics
NPI:1215139720
Name:CREEKSIDE COUNSELING INC
Entity type:Organization
Organization Name:CREEKSIDE COUNSELING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAHARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MS CDS III
Authorized Official - Phone:503-371-4160
Mailing Address - Street 1:PO BOX 4169
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302
Mailing Address - Country:US
Mailing Address - Phone:503-371-4160
Mailing Address - Fax:503-375-9727
Practice Address - Street 1:2586 12TH PLACE SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302
Practice Address - Country:US
Practice Address - Phone:503-371-4160
Practice Address - Fax:503-375-9727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty