Provider Demographics
NPI:1831677079
Name:CREATIVE CALM COUNSELING LLC
Entity Type:Organization
Organization Name:CREATIVE CALM COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ART PSHYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:JIROVETZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:920-267-8322
Mailing Address - Street 1:2380 STATE ROAD 44 STE G
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-6440
Mailing Address - Country:US
Mailing Address - Phone:920-267-8322
Mailing Address - Fax:844-272-1439
Practice Address - Street 1:2380 STATE ROAD 44 STE G
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-6440
Practice Address - Country:US
Practice Address - Phone:920-267-8322
Practice Address - Fax:844-272-1439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43735200Medicaid