MEDICARE: CREATE AWARENESS THERAPY STUDIO

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1619478914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATE AWARENESS THERAPY STUDIO

Provider Business Mailing Address
First Line	:	627 N WEBER ST STE 9
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-5008
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	627 N WEBER ST STE 9
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-5008
Country	:	US
Telephone Number	:	719-313-2011
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHELLE MORRISSEY
Credential	:
Telephone Number	:	719-313-2011

Provider Enumeration Date	:	02/22/2018
Last Update Date	:	10/24/2018

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