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General NPI Number Information
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NPI Number | 1144607961
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Entity Type | Organization
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Legal Business Name | CREATIVE ROOTS THERAPY LLC
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Dates
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Enumeration Date | 04/30/2015
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Last Update Date | 07/18/2015
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Provider Practice Location Address
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Address Line | 375 PARK AVE SUITE B
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City | COOS BAY
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State | OR
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Zip | 97420
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Country | US
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Telephone | 541-808-4719
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 576
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City | COOS BAY
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State | OR
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Zip | 97420
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Country | US
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Telephone | 541-808-4719
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | ERIN ELIZABETH SPIER
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Credential | LPC
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Telephone | 541-808-4719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C3450
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License Number State | OR
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