Provider Demographics
NPI:1598274599
Name:CREATIVE COUNSELING GROUP, PLC
Entity Type:Organization
Organization Name:CREATIVE COUNSELING GROUP, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DELUHERY-WAGEMESTER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:319-200-1022
Mailing Address - Street 1:3801 RIVER RIDGE DR NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-7590
Mailing Address - Country:US
Mailing Address - Phone:319-200-1022
Mailing Address - Fax:319-200-2062
Practice Address - Street 1:3801 RIVER RIDGE DR NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-7590
Practice Address - Country:US
Practice Address - Phone:319-200-1022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-22
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty