Provider Demographics
NPI:1164575288
Name:CREATIVE COUNSELING SERVICES
Entity Type:Organization
Organization Name:CREATIVE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATLIKH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MFT
Authorized Official - Phone:860-529-8977
Mailing Address - Street 1:21 RHODES RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-1856
Mailing Address - Country:US
Mailing Address - Phone:860-257-1865
Mailing Address - Fax:860-257-1865
Practice Address - Street 1:21 RHODES RD
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1856
Practice Address - Country:US
Practice Address - Phone:860-257-1865
Practice Address - Fax:860-257-1865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000921106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT410000921CT03OtherANTHEM
CT351220OtherMHN
CT7760595OtherAETNA