Provider Demographics
NPI:1932499753
Name:CREATIVE MENTAL HEALTH, LLC
Entity Type:Organization
Organization Name:CREATIVE MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELEN
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:SPROLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:702-499-3456
Mailing Address - Street 1:2852 KINKNOCKIE WAY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044-0250
Mailing Address - Country:US
Mailing Address - Phone:702-499-3456
Mailing Address - Fax:702-946-0830
Practice Address - Street 1:701 N GREEN VALLEY PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-6177
Practice Address - Country:US
Practice Address - Phone:702-499-3456
Practice Address - Fax:702-946-0830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP0006101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100520257Medicaid