Provider Demographics
NPI:1619621992
Name:CREATIVE SOUL JOURNEY AND COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:CREATIVE SOUL JOURNEY AND COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ZAX
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:561-212-6224
Mailing Address - Street 1:2101 VISTA PKWY STE 266
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-2706
Mailing Address - Country:US
Mailing Address - Phone:561-212-6224
Mailing Address - Fax:
Practice Address - Street 1:2101 VISTA PKWY STE 266
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-2706
Practice Address - Country:US
Practice Address - Phone:561-212-6224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty