Provider Demographics
NPI:1285836437
Name:CREATIVE COUNSELING ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CREATIVE COUNSELING ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORINNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:COSTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, ATR-BC
Authorized Official - Phone:630-837-5303
Mailing Address - Street 1:848 W BARTLETT RD
Mailing Address - Street 2:SUITE 12E
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-4493
Mailing Address - Country:US
Mailing Address - Phone:630-837-5303
Mailing Address - Fax:630-837-5305
Practice Address - Street 1:848 W BARTLETT RD
Practice Address - Street 2:SUITE 12E
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-4493
Practice Address - Country:US
Practice Address - Phone:630-837-5303
Practice Address - Fax:630-837-5305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL96178101Y00000X
IL180005808101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX ID