Healthcare Provider Details

I. General information

NPI: 1447421003
Provider Name (Legal Business Name): CREATIVE COUNSELING SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 03/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2653 W ELM ST
LIMA OH
45805-2506
US

IV. Provider business mailing address

2653 W ELM ST
LIMA OH
45805-2506
US

V. Phone/Fax

Practice location:
  • Phone: 419-222-5449
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: WENDY VANCE
Title or Position: BILLING SPECIALIST
Credential:
Phone: 937-592-9545