Provider Demographics
NPI:1841564770
Name:CREATIVE HEALING SERVICES, LLC
Entity Type:Organization
Organization Name:CREATIVE HEALING SERVICES, LLC
Other - Org Name:CREATIVE HEALING SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:KUCHTA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, ATR
Authorized Official - Phone:203-600-8900
Mailing Address - Street 1:236 BOSTON POST ROAD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477
Mailing Address - Country:US
Mailing Address - Phone:203-600-8900
Mailing Address - Fax:203-306-3003
Practice Address - Street 1:236 BOSTON POST ROAD
Practice Address - Street 2:SUITE 8
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477
Practice Address - Country:US
Practice Address - Phone:203-600-8900
Practice Address - Fax:203-306-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002087101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008035402Medicaid