Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053542886 |
---|---|
Provider Name | Steven Lee Creech |
First Address | Joshua Tree, CA 92252-2606 |
Second Address | Yucca Valley, CA 92284-7307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2009 |
Last Update Date | 28/07/2009 |