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General NPI Number Information
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NPI Number | 1609196898
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Entity Type | Organization
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Legal Business Name | THE CREATIVE THERAPY CENTER, LLC
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Dates
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Enumeration Date | 06/10/2010
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 815 HIGHWAY 10 STE 102
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City | ELK RIVER
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State | MN
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Zip | 55330-5204
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Country | US
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Telephone | 763-274-0510
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Fax |
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Provider Business Mailing Address
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Address Line | 657 MAIN ST NW STE 214
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City | ELK RIVER
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State | MN
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Zip | 55330-1584
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Country | US
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Telephone | 763-274-0510
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. NICOLE RENEE-HAUSER BAKER
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Credential | PHD, LMFT, RPT
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Telephone | 763-274-0510
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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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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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