Provider Demographics
NPI:1316573991
Name:CREATIVE DIRECTIONS COUNSELING & CONSULTING, LLC
Entity Type:Organization
Organization Name:CREATIVE DIRECTIONS COUNSELING & CONSULTING, LLC
Other - Org Name:KYRA LOGSDON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGSDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-208-2682
Mailing Address - Street 1:PO BOX 40305
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-0305
Mailing Address - Country:US
Mailing Address - Phone:970-208-2682
Mailing Address - Fax:
Practice Address - Street 1:3057 HILL AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-2607
Practice Address - Country:US
Practice Address - Phone:970-208-2682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-16
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty