Provider Demographics
NPI:1720572142
Name:CREATIVE COUNSELING AND COACHING LLC
Entity Type:Organization
Organization Name:CREATIVE COUNSELING AND COACHING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:MAGUN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:203-675-3739
Mailing Address - Street 1:53 WHITNEY GLN
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-3701
Mailing Address - Country:US
Mailing Address - Phone:203-675-3739
Mailing Address - Fax:203-693-3427
Practice Address - Street 1:431 POST RD E STE 14
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4403
Practice Address - Country:US
Practice Address - Phone:203-675-3739
Practice Address - Fax:203-693-3427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-19
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000583101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty