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General NPI Number Information
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NPI Number | 1710281910
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Entity Type | Organization
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Legal Business Name | CREATIVE COUNSELING SERVICES
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Dates
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Enumeration Date | 01/03/2011
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Last Update Date | 01/03/2011
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Provider Practice Location Address
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Address Line | 17127 OAK PARK AVE
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City | TINLEY PARK
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State | IL
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Zip | 60477-3405
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Country | US
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Telephone | 708-288-9366
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Fax |
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Provider Business Mailing Address
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Address Line | 17127 OAK PARK AVE
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City | TINLEY PARK
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State | IL
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Zip | 60477-3405
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Country | US
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Telephone | 708-288-9366
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAUL JAMES NEWMAN
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Credential | LCSW
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Telephone | 708-288-9366
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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 | 149-007860
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License Number State | IL
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