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General NPI Number Information
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NPI Number | 1730581646
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Entity Type | Organization
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Legal Business Name | CREATE INC
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Dates
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Enumeration Date | 09/23/2014
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 1145 SHENANDOAH LN N
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City | PLYMOUTH
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State | MN
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Zip | 55447-3201
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Country | US
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Telephone | 612-596-0100
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Fax | 612-321-3807
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Provider Business Mailing Address
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Address Line | 1911 PLEASANT AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55403-3506
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Country | US
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Telephone | 612-874-9811
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Fax | 612-874-9820
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Authorized Official
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Title or Position | DIRECTOR
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Name | LYNN ALLER
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Credential |
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Telephone | 612-874-9811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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