Healthcare Provider Details

I. General information

NPI: 1508589250
Provider Name (Legal Business Name): CREATIVE HEALING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 03/05/2023
Certification Date: 03/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E 29TH ST STE 215
LOVELAND CO
80538-2765
US

IV. Provider business mailing address

1304 LOCH MOUNT DR
LOVELAND CO
80537-4539
US

V. Phone/Fax

Practice location:
  • Phone: 970-342-5440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TAMMY BRANNEN
Title or Position: OWNER
Credential:
Phone: 970-342-5440