Healthcare Provider Details

I. General information

NPI: 1114782752
Provider Name (Legal Business Name): CREATIVE LIFE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 WASHTENAW AVE STE 2
ANN ARBOR MI
48104-4525
US

IV. Provider business mailing address

8441 PAWNEE TRL
PINCKNEY MI
48169-9391
US

V. Phone/Fax

Practice location:
  • Phone: 734-707-8420
  • Fax:
Mailing address:
  • Phone: 734-707-8420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHERINE MUNTER
Title or Position: CLINICAL PSYCHOLOGIST
Credential: LP
Phone: 734-707-8420