Provider Demographics
NPI:1043602121
Name:CREATIVE COUNSELING FOR ELDERS AND FAMILIES
Entity Type:Organization
Organization Name:CREATIVE COUNSELING FOR ELDERS AND FAMILIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DREW
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:707-239-2310
Mailing Address - Street 1:141 NORTH ST STE C
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3821
Mailing Address - Country:US
Mailing Address - Phone:707-239-2310
Mailing Address - Fax:707-737-5520
Practice Address - Street 1:141 NORTH ST STE C
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3821
Practice Address - Country:US
Practice Address - Phone:707-239-2310
Practice Address - Fax:707-737-5520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42079251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management