Healthcare Provider Details

I. General information

NPI: 1932499753
Provider Name (Legal Business Name): CREATIVE MENTAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N GREEN VALLEY PKWY SUITE 200
HENDERSON NV
89074-6177
US

IV. Provider business mailing address

2852 KINKNOCKIE WAY
HENDERSON NV
89044-0250
US

V. Phone/Fax

Practice location:
  • Phone: 702-499-3456
  • Fax: 702-946-0830
Mailing address:
  • Phone: 702-499-3456
  • Fax: 702-946-0830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCP0006
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCP0006
License Number StateNV

VIII. Authorized Official

Name: ELEN MICHELE SPROLE
Title or Position: OWNER
Credential: LCPC
Phone: 702-499-3456