Healthcare Provider Details

I. General information

NPI: 1578192100
Provider Name (Legal Business Name): CREATIVE FORCES THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S BEDFORD ST STE 7
MADISON WI
53703-3695
US

IV. Provider business mailing address

301 S BEDFORD ST STE 7
MADISON WI
53703-3695
US

V. Phone/Fax

Practice location:
  • Phone: 608-313-4060
  • Fax: 608-999-7339
Mailing address:
  • Phone: 608-313-4060
  • Fax: 608-999-7339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN SCHMIDT
Title or Position: OWNER
Credential:
Phone: 608-313-4060