Provider Demographics
NPI:1013509645
Name:CREATIVE THERAPEUTIC SPACE, PLLC
Entity Type:Organization
Organization Name:CREATIVE THERAPEUTIC SPACE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTAL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:903-292-7681
Mailing Address - Street 1:22400 WESTHEIMER PKWY APT 310
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-8268
Mailing Address - Country:US
Mailing Address - Phone:832-779-3201
Mailing Address - Fax:
Practice Address - Street 1:23211 RED RIVER DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-2031
Practice Address - Country:US
Practice Address - Phone:832-779-3201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty