Provider Demographics
NPI:1679217640
Name:CREATIVE CONSULTANT COUNSELING
Entity Type:Organization
Organization Name:CREATIVE CONSULTANT COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUDERDALE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-810-5373
Mailing Address - Street 1:6051 N BROOKLINE AVE STE 135A
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4297
Mailing Address - Country:US
Mailing Address - Phone:405-810-5373
Mailing Address - Fax:405-242-3001
Practice Address - Street 1:6051 N BROOKLINE AVE STE 135A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4297
Practice Address - Country:US
Practice Address - Phone:405-810-5373
Practice Address - Fax:405-242-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty