Provider Demographics
NPI:1740871201
Name:CREATIVE JOURNEY, LLC
Entity type:Organization
Organization Name:CREATIVE JOURNEY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAULEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:IVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS OTR/L
Authorized Official - Phone:701-658-9032
Mailing Address - Street 1:419 5TH ST NE STE 142
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-3318
Mailing Address - Country:US
Mailing Address - Phone:701-658-9032
Mailing Address - Fax:
Practice Address - Street 1:419 5TH ST NE STE 142
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-3318
Practice Address - Country:US
Practice Address - Phone:701-658-9032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty