Provider Demographics
NPI:1437209681
Name:CENTER FOR CREATIVE CHANGE, INC.
Entity Type:Organization
Organization Name:CENTER FOR CREATIVE CHANGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:MATTINGLY
Authorized Official - Last Name:LANGLOIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LMFT
Authorized Official - Phone:317-845-5133
Mailing Address - Street 1:100 NORTHLAND ST
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1147
Mailing Address - Country:US
Mailing Address - Phone:317-845-5133
Mailing Address - Fax:317-845-5133
Practice Address - Street 1:100 NORTHLAND ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1147
Practice Address - Country:US
Practice Address - Phone:317-845-5133
Practice Address - Fax:317-845-5133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN340021871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty