Provider Demographics
NPI:1427409697
Name:NORTHWEST CREATIVE THERAPY LLC
Entity Type:Organization
Organization Name:NORTHWEST CREATIVE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, ATR-BC
Authorized Official - Phone:503-333-5535
Mailing Address - Street 1:1744 NE 42ND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1537
Mailing Address - Country:US
Mailing Address - Phone:503-333-5535
Mailing Address - Fax:
Practice Address - Street 1:1744 NE 42ND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1537
Practice Address - Country:US
Practice Address - Phone:503-333-5535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4168251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health