Healthcare Provider Details

I. General information

NPI: 1932020807
Provider Name (Legal Business Name): CREATIVE HEALING THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 SE 4TH CT
DANIA BEACH FL
33004-4737
US

IV. Provider business mailing address

650 SE 4TH CT
DANIA BEACH FL
33004-4737
US

V. Phone/Fax

Practice location:
  • Phone: 786-202-1197
  • Fax:
Mailing address:
  • Phone: 786-202-1197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA COHEN
Title or Position: CEO
Credential: LMFT
Phone: 786-202-1197