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General NPI Number Information
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NPI Number | 1326512039
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Entity Type | Organization
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Legal Business Name | CREATIVE INSIGHT COUNSELING
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Dates
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Enumeration Date | 01/15/2019
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Last Update Date | 01/15/2019
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Provider Practice Location Address
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Address Line | 3309 WINTHROP AVE STE 76
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City | FORT WORTH
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State | TX
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Zip | 76116-5600
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Country | US
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Telephone | 206-226-4249
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Fax |
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Provider Business Mailing Address
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Address Line | 1114 WARDEN ST
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City | BENBROOK
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State | TX
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Zip | 76126-3526
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Country | US
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Telephone | 206-226-4249
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROSANA E MINA-MEZA
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Credential | LPC
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Telephone | 206-226-4249
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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