Provider Demographics
NPI:1326512039
Name:CREATIVE INSIGHT COUNSELING
Entity Type:Organization
Organization Name:CREATIVE INSIGHT COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSANA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MINA-MEZA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:206-226-4249
Mailing Address - Street 1:1114 WARDEN ST
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-3526
Mailing Address - Country:US
Mailing Address - Phone:206-226-4249
Mailing Address - Fax:
Practice Address - Street 1:3309 WINTHROP AVE STE 76
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5600
Practice Address - Country:US
Practice Address - Phone:206-226-4249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health