Provider Demographics
NPI:1154488773
Name:CREATIVE COUNSELING SERVICES
Entity Type:Organization
Organization Name:CREATIVE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHAIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:765-827-5610
Mailing Address - Street 1:1956 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-2858
Mailing Address - Country:US
Mailing Address - Phone:765-827-5610
Mailing Address - Fax:765-825-9440
Practice Address - Street 1:1956 OHIO AVE
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-2858
Practice Address - Country:US
Practice Address - Phone:765-827-5610
Practice Address - Fax:765-825-9440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004224A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty