Healthcare Provider Details

I. General information

NPI: 1548968266
Provider Name (Legal Business Name): CREATIVITY FOR ALL COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 RANCH DR
FARMINGTON NM
87401-2572
US

IV. Provider business mailing address

2100 RANCH DR
FARMINGTON NM
87401-2572
US

V. Phone/Fax

Practice location:
  • Phone: 505-259-1574
  • Fax:
Mailing address:
  • Phone: 505-259-1574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARGARET (MEG) CARLSON
Title or Position: LICENSED CLINICIAL COUNSELOR
Credential: LPCC
Phone: 505-259-1574