Provider Demographics
NPI:1184953929
Name:CREATIVE COUNSELING CENTER, INC.
Entity type:Organization
Organization Name:CREATIVE COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:COWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:618-632-0701
Mailing Address - Street 1:PO BOX 701
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-0701
Mailing Address - Country:US
Mailing Address - Phone:618-632-0701
Mailing Address - Fax:618-222-1370
Practice Address - Street 1:701 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-2665
Practice Address - Country:US
Practice Address - Phone:618-632-0701
Practice Address - Fax:618-222-1370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000342106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty