Provider Demographics
NPI:1851880975
Name:CREATIVE REFLECTIONS COUNSELING, LLC
Entity Type:Organization
Organization Name:CREATIVE REFLECTIONS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:DIANA
Authorized Official - Last Name:STIMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:814-272-1300
Mailing Address - Street 1:315 S ALLEN ST STE 124B
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-4863
Mailing Address - Country:US
Mailing Address - Phone:814-272-1300
Mailing Address - Fax:814-954-4861
Practice Address - Street 1:315 S ALLEN ST STE 124B
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801
Practice Address - Country:US
Practice Address - Phone:814-272-1300
Practice Address - Fax:814-954-4861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-03
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006346101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102723284-0002Medicaid