| Creekside Counseling Center, Llc | |
|
132 S. Broad St. #101 Canfield OH 44406 | |
| (330) 533-5450 | |
| (330) 533-4292 |
| Full Name | Creekside Counseling Center, Llc |
|---|---|
| Speciality | Counselor |
| Location | 132 S. Broad St. #101, Canfield, Ohio |
| Authorized Official Name and Position | Thomas Richard Kupec (DIRECTOR/OWNER) |
| Authorized Official Contact | 3305335450 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Creekside Counseling Center, Llc 132 S. Broad St. #101 Canfield OH 44406 Ph: (330) 533-5450 | Creekside Counseling Center, Llc 132 S. Broad St. #101 Canfield OH 44406 Ph: (330) 533-5450 |
| NPI Number | 1518192608 |
|---|---|
| Provider Enumeration Date | 05/19/2009 |
| Last Update Date | 02/13/2023 |
| Certification Date | 02/13/2023 |
| Medicare PECOS PAC ID | 7113364597 |
|---|---|
| Medicare Enrollment ID | O20240320003889 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518192608 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | E-0003444-SUPV (Ohio) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Thomas R Kupec |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1457320889 PECOS PAC ID: 8527069418 Enrollment ID: I20240320003957 |
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