Provider Demographics
NPI:1881979821
Name:CREATIVE LIFE COUNSELING SERVICES
Entity type:Organization
Organization Name:CREATIVE LIFE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:E
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-576-7032
Mailing Address - Street 1:1925 N. MILWAUKEE AVE.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4345
Mailing Address - Country:US
Mailing Address - Phone:773-576-7032
Mailing Address - Fax:773-486-1345
Practice Address - Street 1:1925 N. MILWAUKEE AVE.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4345
Practice Address - Country:US
Practice Address - Phone:773-576-7032
Practice Address - Fax:773-486-1345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007233251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health