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General NPI Number Information
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NPI Number | 1346488491
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Entity Type | Organization
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Legal Business Name | CREATIVE CHANGE, INC.
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Dates
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Enumeration Date | 01/28/2009
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Last Update Date | 01/28/2009
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Provider Practice Location Address
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Address Line | 5331 COMMERCIAL WAY STE 212
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City | SPRING HILL
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State | FL
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Zip | 34606-1426
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Country | US
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Telephone | 352-597-0969
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Fax | 352-597-6853
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Provider Business Mailing Address
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Address Line | 5331 COMMERCIAL WAY STE 212
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City | SPRING HILL
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State | FL
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Zip | 34606-1426
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Country | US
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Telephone | 352-597-0969
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Fax | 352-597-6853
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TED ROBERT PEARSON
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Credential | M.A., LMHC
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Telephone | 352-597-0969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH2746
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License Number State | FL
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