MEDICARE: CREATIVE THERAPY SOLUTIONS

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	1041C0700X	Clinical Social Worker	2007005112	MO

General Provider Information

NPI Number	:	1811329949
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATIVE THERAPY SOLUTIONS

Provider Business Mailing Address
First Line	:	2905 W 72ND ST
Second Line	:
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66208-3149
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2905 W 72ND ST
Second Line	:
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66208-3149
Country	:	US
Telephone Number	:	913-638-8896
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	MRS. AMY SANDY
Credential	:	LCSW
Telephone Number	:	913-638-8896

Provider Enumeration Date	:	07/31/2013
Last Update Date	:	07/31/2013

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