Provider Demographics
NPI:1477138253
Name:CREATIVE GROWTH THERAPY
Entity Type:Organization
Organization Name:CREATIVE GROWTH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:I
Authorized Official - Last Name:DEBRYN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, ATR
Authorized Official - Phone:504-407-1713
Mailing Address - Street 1:3584 W OUTER DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-1662
Mailing Address - Country:US
Mailing Address - Phone:248-396-4602
Mailing Address - Fax:
Practice Address - Street 1:3584 W OUTER DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-1662
Practice Address - Country:US
Practice Address - Phone:248-396-4602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-13
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty