Provider Demographics
NPI:1629652078
Name:CREATIVE PATH COUNSELING LLC
Entity Type:Organization
Organization Name:CREATIVE PATH COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LACASSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-706-9325
Mailing Address - Street 1:16069 TAMPA ST
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34604-8458
Mailing Address - Country:US
Mailing Address - Phone:203-706-9325
Mailing Address - Fax:
Practice Address - Street 1:16069 TAMPA ST
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34604-8458
Practice Address - Country:US
Practice Address - Phone:203-706-9325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL220-520-68-662-0OtherFLORIDA DRIVER LICENSE