Healthcare Provider Details

I. General information

NPI: 1821254368
Provider Name (Legal Business Name): CREATIVE THERAPY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S MAIN AVE
MINNEOLA FL
34715-9578
US

IV. Provider business mailing address

1138 EVEREST STREET
CLERMONT FL
34711
US

V. Phone/Fax

Practice location:
  • Phone: 407-399-8855
  • Fax: 321-248-0120
Mailing address:
  • Phone: 407-376-9277
  • Fax: 321-248-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH7529
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW5509
License Number StateFL

VIII. Authorized Official

Name: CHRISTINE TUZZO HARRIS
Title or Position: OWNER/PRESIDENT
Credential: MSW, LCSW
Phone: 407-376-9277