Provider Demographics
NPI:1568762334
Name:CREATIVE COUNSELING INC
Entity Type:Organization
Organization Name:CREATIVE COUNSELING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THIRD PARTY
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-669-8451
Mailing Address - Street 1:2809 KIRBY RD
Mailing Address - Street 2:116
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-8246
Mailing Address - Country:US
Mailing Address - Phone:901-759-4772
Mailing Address - Fax:
Practice Address - Street 1:2809 KIRBY RD
Practice Address - Street 2:116
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-8246
Practice Address - Country:US
Practice Address - Phone:901-759-4772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or Welfare
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty