Healthcare Provider Details

I. General information

NPI: 1326160698
Provider Name (Legal Business Name): CREATIVE HUMAN SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8270 NE BLAKELY HEIGHTS DR
BAINBRIDGE ISLAND WA
98110-2298
US

IV. Provider business mailing address

PO BOX 11516
BAINBRIDGE ISLAND WA
98110-5516
US

V. Phone/Fax

Practice location:
  • Phone: 505-463-2685
  • Fax: 866-531-2893
Mailing address:
  • Phone: 505-463-2685
  • Fax: 866-531-2893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberI-4133
License Number StateNM

VIII. Authorized Official

Name: MS. LYSSA MICHELLE DANEHY
Title or Position: OWNER
Credential: LISW
Phone: 505-463-2685