Provider Demographics
NPI:1558889071
Name:CREATIVE CLINICAL CONSULTING LLC
Entity Type:Organization
Organization Name:CREATIVE CLINICAL CONSULTING LLC
Other - Org Name:CENTER FOR CREATIVE ARTS THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:AZIZI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:847-477-8244
Mailing Address - Street 1:2600 WARRENVILLE ROAD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1761
Mailing Address - Country:US
Mailing Address - Phone:847-477-8244
Mailing Address - Fax:
Practice Address - Street 1:2600 WARRENVILLE ROAD
Practice Address - Street 2:SUITE 205
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1761
Practice Address - Country:US
Practice Address - Phone:847-477-8244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-05
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009321101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty