Healthcare Provider Details

I. General information

NPI: 1619621992
Provider Name (Legal Business Name): CREATIVE SOUL JOURNEY AND COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 VISTA PKWY STE 266
WEST PALM BEACH FL
33411-2706
US

IV. Provider business mailing address

2101 VISTA PKWY STE 266
WEST PALM BEACH FL
33411-2706
US

V. Phone/Fax

Practice location:
  • Phone: 561-212-6224
  • Fax:
Mailing address:
  • Phone: 561-212-6224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIA S ZAX
Title or Position: CLINICAL MENTAL HEALTH COUNSELOR
Credential: LMHC
Phone: 561-212-6224