Provider Demographics
NPI:1184016446
Name:CREATIVE THERAPY, INC.
Entity Type:Organization
Organization Name:CREATIVE THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:TYSON MARCHINO
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:808-652-2862
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:KALAHEO
Mailing Address - State:HI
Mailing Address - Zip Code:96741-0339
Mailing Address - Country:US
Mailing Address - Phone:808-652-2862
Mailing Address - Fax:808-320-3933
Practice Address - Street 1:3483 WELIWELI RD
Practice Address - Street 2:SUITE #1
Practice Address - City:KOLOA
Practice Address - State:HI
Practice Address - Zip Code:96756-8546
Practice Address - Country:US
Practice Address - Phone:808-652-2862
Practice Address - Fax:808-320-3933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT350106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty