MEDICARE: CREATIVE MIND HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1336013986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATIVE MIND HEALTH, LLC

Provider Business Mailing Address
First Line	:	10420 S RIDGEVIEW RD UNIT 2069
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66061-6438
Country	:	US
Telephone Number	:	913-275-0709
Fax Number	:

Provider Business Practice Location Address
First Line	:	7280 NW 87TH TER STE C210
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64153-3720
Country	:	US
Telephone Number	:	913-395-3300
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL SUPERVISOR
Name	:	MS. JESSICA L WATERS
Credential	:	LCAC, LADC, ADDC
Telephone Number	:	913-275-0709

Provider Enumeration Date	:	10/06/2025
Last Update Date	:	05/24/2026

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