Provider Demographics
NPI:1710695648
Name:CREATIVE COUNSELING 4 KIDS LLC
Entity Type:Organization
Organization Name:CREATIVE COUNSELING 4 KIDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHZAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-696-6157
Mailing Address - Street 1:396 NORTH BERRY ROAD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122
Mailing Address - Country:US
Mailing Address - Phone:949-696-6157
Mailing Address - Fax:
Practice Address - Street 1:2025 S BRENTWOOD BLVD SUITE 201
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144
Practice Address - Country:US
Practice Address - Phone:949-696-6157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty