Provider Demographics
NPI:1609807098
Name:CREATIVE LIVING CENTER, P.C.
Entity Type:Organization
Organization Name:CREATIVE LIVING CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAYTON
Authorized Official - Middle Name:J
Authorized Official - Last Name:VOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:712-476-5245
Mailing Address - Street 1:1905 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51247-1630
Mailing Address - Country:US
Mailing Address - Phone:712-476-5245
Mailing Address - Fax:712-476-9621
Practice Address - Street 1:1905 10TH ST
Practice Address - Street 2:
Practice Address - City:ROCK VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51247-1630
Practice Address - Country:US
Practice Address - Phone:712-476-5245
Practice Address - Fax:712-476-9621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00226101Y00000X
IA00865101Y00000X
IA060991041C0700X
IA00002106H00000X
IA00041106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0451252Medicaid
IA37804OtherGROUP BLUE CROSS
IAE48770Medicare UPIN
IA0451252Medicaid
IAG21784Medicare UPIN