Healthcare Provider Details

I. General information

NPI: 1538400882
Provider Name (Legal Business Name): CREATIVE SOLUTIONS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 EAST PARIS AVE SE STE 203
GRAND RAPIDS MI
49546-2426
US

IV. Provider business mailing address

2305 EAST PARIS AVE SE STE 203
GRAND RAPIDS MI
49546-2426
US

V. Phone/Fax

Practice location:
  • Phone: 616-929-0226
  • Fax: 866-496-2998
Mailing address:
  • Phone: 616-929-0226
  • Fax: 866-496-2998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401012156
License Number StateMI

VIII. Authorized Official

Name: JOSEPH PAUL MARTINO
Title or Position: PARTNER/THERAPIST
Credential: LLPC
Phone: 616-929-0226