Creekside Therapeutics

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

CREEKSIDE THERAPEUTICS

Practice address

137 Laxton Rd Ste 200
Lynchburg, VA 24502-5294

Phone

(434) 515-2041

NPI assigned

Apr 19, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jessica Coleman, LPC, BCBANPI 1548797459

Title

Owner

Phone

(434) 515-2041

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jessica Coleman

  • Mental Health Counselor
  • Lynchburg, VA
  • NPI 1548797459

  Behavior Analyst

  Medicare reassignment NPD Authorized official
• Heidi Olson, MA RESIDENT IN COUNS

  • Counselor
  • Lynchburg, VA
  • NPI 1407699275
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723593600000",
    "number": "1902593015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "137 LAXTON RD STE 200",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245025294",
            "telephone_number": "434-515-2041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "137 LAXTON RD STE 200",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245025294",
            "telephone_number": "434-515-2041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEKSIDE THERAPEUTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-19",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-14",
        "status": "A",
        "authorized_official_last_name": "COLEMAN",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "434-515-2041",
        "authorized_official_credential": "LPC, BCBA"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30017547490002",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Megan Casey Crawford, FNP
• Jimmy Lowe Creamer Jr.
• Jessica Lynette Creasey
• Credence Behavioral Health PLLC
• Paula Deane Creekmore, NNP-BC
• Kelsie Barksdale Crenshaw
• David H Cresson Jr., M.D.
• Kimberly Anne Crews, RPRS
• William David Crews Jr., PH.D.
• Frank Calvin Crist Jr., D.D.S.

• Professional Counselor in Lynchburg, VA
• Providers in Lynchburg, VA by specialty
• Professional Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.