Provider Demographics
NPI:1437337029
Name:CREATIVE PATHWAYS TO WHOLENESS, LLC
Entity Type:Organization
Organization Name:CREATIVE PATHWAYS TO WHOLENESS, LLC
Other - Org Name:CREATIVE PATHS
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:N
Authorized Official - Last Name:ST. CLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, ATR-BC
Authorized Official - Phone:314-644-4422
Mailing Address - Street 1:7750 CLAYTON RD
Mailing Address - Street 2:SUITE 308 A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1353
Mailing Address - Country:US
Mailing Address - Phone:314-644-4422
Mailing Address - Fax:
Practice Address - Street 1:7750 CLAYTON RD
Practice Address - Street 2:SUITE 308 A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1353
Practice Address - Country:US
Practice Address - Phone:314-644-4422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW000038381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490614104Medicaid
MO209651OtherANTHEM BCBS
MO209651OtherANTHEM BCBS