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General NPI Number Information
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NPI Number | 1336304153
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Entity Type | Organization
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Legal Business Name | CREATIVE COUNSELING AND INTERVENTION SERVICES, INC.
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Dates
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Enumeration Date | 07/21/2008
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Last Update Date | 08/22/2013
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Provider Practice Location Address
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Address Line | 208 5TH ST SUITE 103
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City | AMES
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State | IA
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Zip | 50010-6272
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Country | US
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Telephone | 515-233-1699
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Fax |
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Provider Business Mailing Address
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Address Line | 208 5TH ST SUITE 103
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City | AMES
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State | IA
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Zip | 50010-6272
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KRISTTEN M. BUTTERMORE
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Credential | LMHC
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Telephone | 515-233-1699
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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 | 00921
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License Number State | IA
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