Provider Demographics
NPI:1336304153
Name:CREATIVE COUNSELING AND INTERVENTION SERVICES, INC.
Entity Type:Organization
Organization Name:CREATIVE COUNSELING AND INTERVENTION SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTTEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUTTERMORE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:515-233-1699
Mailing Address - Street 1:208 5TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-6272
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:208 5TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6272
Practice Address - Country:US
Practice Address - Phone:515-233-1699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CREATIVE COUNSELING SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-21
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00921251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health