Healthcare Provider Details

I. General information

NPI: 1346747169
Provider Name (Legal Business Name): CREATIVE COUNSELING OF MILWAUKEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2266 E PROSPECT AVE SUITE 304
MILWAUKEE WI
53202
US

IV. Provider business mailing address

2022 E EDGEWOOD AVE
SHOREWOOD WI
53211-2935
US

V. Phone/Fax

Practice location:
  • Phone: 414-405-0670
  • 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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CRAIG STONE
Title or Position: PARTNER
Credential: MAC, LPC
Phone: 414-405-0670