Provider Demographics
NPI:1225438773
Name:CREATIVE COUNSELING CENTER
Entity Type:Organization
Organization Name:CREATIVE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SAWDEY-ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-879-5838
Mailing Address - Street 1:808 W CHICAGO BLVD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-1666
Mailing Address - Country:US
Mailing Address - Phone:517-879-5838
Mailing Address - Fax:
Practice Address - Street 1:808 W CHICAGO BLVD
Practice Address - Street 2:SUITE 14
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-1666
Practice Address - Country:US
Practice Address - Phone:517-879-5838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009777101YP2500X
MI6801092595104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty