Provider Demographics
NPI:1205077294
Name:CREATIVE PATHWAYS LLC
Entity type:Organization
Organization Name:CREATIVE PATHWAYS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:E
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MSSW
Authorized Official - Phone:502-552-3107
Mailing Address - Street 1:608 HOPKINS LN
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-5034
Mailing Address - Country:US
Mailing Address - Phone:502-552-3107
Mailing Address - Fax:
Practice Address - Street 1:639 EASTERN BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-2460
Practice Address - Country:US
Practice Address - Phone:502-552-3107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003596A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1639175771OtherINDIVIDUAL NPI (TYPE I)