Provider Demographics
NPI:1891260717
Name:CREATIVE FAMILY COUNSELING
Entity Type:Organization
Organization Name:CREATIVE FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-709-0410
Mailing Address - Street 1:8134 NEW LAGRANGE ROAD
Mailing Address - Street 2:SUITE 227
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-3237
Mailing Address - Country:US
Mailing Address - Phone:502-709-0410
Mailing Address - Fax:
Practice Address - Street 1:8134 NEW LAGRANGE ROAD
Practice Address - Street 2:SUITE 227
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222
Practice Address - Country:US
Practice Address - Phone:502-709-0410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-07
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty