Provider Demographics
NPI:1265621874
Name:CREATIVE PSYCHOPHARMACOLOGY INC
Entity type:Organization
Organization Name:CREATIVE PSYCHOPHARMACOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUESKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-333-9954
Mailing Address - Street 1:701 25TH AVE S
Mailing Address - Street 2:#303
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1513
Mailing Address - Country:US
Mailing Address - Phone:612-333-9954
Mailing Address - Fax:612-333-9969
Practice Address - Street 1:701 25TH AVE S
Practice Address - Street 2:#303
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1513
Practice Address - Country:US
Practice Address - Phone:612-333-9954
Practice Address - Fax:612-333-9969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN90764122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty