Provider Demographics
NPI:1013430479
Name:CREATE HEALING COUNSELING SERVICES PLLC
Entity type:Organization
Organization Name:CREATE HEALING COUNSELING SERVICES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STASIA
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:501-940-6135
Mailing Address - Street 1:10 CHERRY CREST CV
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-5437
Mailing Address - Country:US
Mailing Address - Phone:501-940-6135
Mailing Address - Fax:844-235-2943
Practice Address - Street 1:1501 N UNIVERSITY AVE STE 700
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-5297
Practice Address - Country:US
Practice Address - Phone:501-940-6135
Practice Address - Fax:844-235-2943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2011C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1790720415OtherNPI TYPE 1
ARE3982OtherAHIN