Provider Demographics
NPI:1134884125
Name:CREATIVE HEALING STUDIO LLC
Entity type:Organization
Organization Name:CREATIVE HEALING STUDIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOPE
Authorized Official - Middle Name:CECELIA
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC
Authorized Official - Phone:802-734-0538
Mailing Address - Street 1:4004 CARLISLE BLVD NE STE P
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4544
Mailing Address - Country:US
Mailing Address - Phone:802-734-0538
Mailing Address - Fax:
Practice Address - Street 1:4004 CARLISLE BLVD NE STE P
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4544
Practice Address - Country:US
Practice Address - Phone:802-734-0538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)