Provider Demographics
NPI:1275840886
Name:CREATIVE INTERVENTIONS COUNSELING, INC
Entity Type:Organization
Organization Name:CREATIVE INTERVENTIONS COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:219-689-7632
Mailing Address - Street 1:8 MORGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-4836
Mailing Address - Country:US
Mailing Address - Phone:219-689-7632
Mailing Address - Fax:219-462-4741
Practice Address - Street 1:8 MORGAN BLVD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4836
Practice Address - Country:US
Practice Address - Phone:219-689-7632
Practice Address - Fax:219-462-4741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042274A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty