Provider Demographics
NPI:1982313029
Name:CREATIVE CONNECTIONS COUNSELING LLC
Entity Type:Organization
Organization Name:CREATIVE CONNECTIONS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BREANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC, ATR
Authorized Official - Phone:651-300-9654
Mailing Address - Street 1:11990 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-1516
Mailing Address - Country:US
Mailing Address - Phone:651-300-9654
Mailing Address - Fax:
Practice Address - Street 1:11990 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-1516
Practice Address - Country:US
Practice Address - Phone:651-300-9654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CREATIVE CONNECTIONS COUNSELING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty