Provider Demographics
NPI:1205699444
Name:CREATIVE COUNSELING, PLLC
Entity type:Organization
Organization Name:CREATIVE COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:THORSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:224-236-2616
Mailing Address - Street 1:1104 HEDGEROW DR
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-3547
Mailing Address - Country:US
Mailing Address - Phone:847-275-4309
Mailing Address - Fax:
Practice Address - Street 1:1117 S MILWAUKEE AVE STE A12
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5268
Practice Address - Country:US
Practice Address - Phone:224-236-2616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty