Provider Demographics
NPI:1427397637
Name:CENTER FOR CREATIVE GROWTH & HEALING LLC
Entity Type:Organization
Organization Name:CENTER FOR CREATIVE GROWTH & HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:AUBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-359-1885
Mailing Address - Street 1:207 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-9729
Mailing Address - Country:US
Mailing Address - Phone:816-359-1885
Mailing Address - Fax:
Practice Address - Street 1:207 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-9729
Practice Address - Country:US
Practice Address - Phone:816-359-1885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007027921101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty