Provider Demographics
NPI:1033367131
Name:CREATIVE CHANGE COUNSELING
Entity Type:Organization
Organization Name:CREATIVE CHANGE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FOREST
Authorized Official - Middle Name:E
Authorized Official - Last Name:WOODLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-782-5348
Mailing Address - Street 1:1600 DEXTER AVE N.
Mailing Address - Street 2:SUITE C-5
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109
Mailing Address - Country:US
Mailing Address - Phone:206-782-5348
Mailing Address - Fax:206-706-5356
Practice Address - Street 1:1600 DEXTER AVE N
Practice Address - Street 2:SUITE C-5
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-3079
Practice Address - Country:US
Practice Address - Phone:206-782-5348
Practice Address - Fax:206-706-5356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA221251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health