Provider Demographics
NPI:1609395151
Name:CREATIVE HEALING CENTER, PLLC
Entity Type:Organization
Organization Name:CREATIVE HEALING CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SENONA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HAUGENATER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, ATR
Authorized Official - Phone:832-818-0274
Mailing Address - Street 1:7009 JAPONICA ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-2813
Mailing Address - Country:US
Mailing Address - Phone:832-818-0274
Mailing Address - Fax:
Practice Address - Street 1:2200 NORTH LOOP W STE 118
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-1753
Practice Address - Country:US
Practice Address - Phone:832-818-0274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70670261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)