Provider Demographics
NPI:1619308517
Name:CREATIVE COUNSELING SERVICES
Entity Type:Organization
Organization Name:CREATIVE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOMBRYS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:517-862-9378
Mailing Address - Street 1:913 W HOLMES RD
Mailing Address - Street 2:SUITE 179
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-0426
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:913 W HOLMES RD
Practice Address - Street 2:SUITE 179
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-0426
Practice Address - Country:US
Practice Address - Phone:517-862-9378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty