Provider Demographics
NPI:1114302684
Name:THE CREATIVE COUNSELING GROUP
Entity Type:Organization
Organization Name:THE CREATIVE COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:MATTSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:906-370-1668
Mailing Address - Street 1:3215 TOWER AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-5388
Mailing Address - Country:US
Mailing Address - Phone:906-370-1668
Mailing Address - Fax:
Practice Address - Street 1:3215 TOWER AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-5388
Practice Address - Country:US
Practice Address - Phone:906-370-1668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5340101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty