Healthcare Provider Details

I. General information

NPI: 1760288187
Provider Name (Legal Business Name): CREATIVE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10304 BUST SUBDIVISION RD
POTOSI MO
63664-8361
US

IV. Provider business mailing address

10304 BUST SUBDIVISION RD
POTOSI MO
63664-8361
US

V. Phone/Fax

Practice location:
  • Phone: 573-631-2007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: LISA SANDERSON
Title or Position: CEO
Credential:
Phone: 573-631-2007