Healthcare Provider Details

I. General information

NPI: 1184334229
Provider Name (Legal Business Name): CREATIVE HEALING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4620 N RACINE AVE APT 19
CHICAGO IL
60640-4900
US

IV. Provider business mailing address

1343 W IRVING PARK RD UNIT 13469
CHICAGO IL
60613-8323
US

V. Phone/Fax

Practice location:
  • Phone: 708-480-2022
  • Fax:
Mailing address:
  • Phone: 708-480-2022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SARAH A MUELLER
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: MA, LCPC, ATR-BC
Phone: 708-480-2022