Healthcare Provider Details

I. General information

NPI: 1043734049
Provider Name (Legal Business Name): CREATIVE SOLUTIONS COUNSELING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 08/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 14TH ST STE B
MERIDIAN MS
39301-4455
US

IV. Provider business mailing address

154 COUNTY ROAD 163
CORINTH MS
38834
US

V. Phone/Fax

Practice location:
  • Phone: 601-207-5330
  • Fax: 888-735-7202
Mailing address:
  • Phone: 662-286-6565
  • Fax: 888-735-7202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: LASAUNDRA L ROBERTS
Title or Position: SOLE MBR
Credential: PMHNP
Phone: 601-207-5330