Provider Demographics
NPI:1851995641
Name:CREATIVE WISDOM COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:CREATIVE WISDOM COUNSELING SERVICES, LLC
Other - Org Name:CREATIVE WISDOM COUNSELING SERVICES, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MENTAL HEALTH PROFESSIONAL
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:309-989-0052
Mailing Address - Street 1:5016 N UNIVERSITY ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4763
Mailing Address - Country:US
Mailing Address - Phone:309-989-0052
Mailing Address - Fax:
Practice Address - Street 1:5016 N UNIVERSITY ST STE 101
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4763
Practice Address - Country:US
Practice Address - Phone:309-989-0052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-23
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty