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General NPI Number Information
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NPI Number | 1871986828
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Entity Type | Organization
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Legal Business Name | CREATIVE HEALING ARTS & COUNSELING LLC
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Dates
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Enumeration Date | 03/16/2015
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 203 E WISCOSIN AVE SUITE 302
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City | OCONOMOWOC
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State | WI
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Zip | 53066-3141
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Country | US
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Telephone | 414-429-6403
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Fax | 262-354-0971
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Provider Business Mailing Address
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Address Line | 1085 REVERE DR
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City | OCONOMOWOC
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State | WI
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Zip | 53066-4422
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Country | US
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Telephone | 414-429-6403
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Fax | 262-354-0971
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | PATRICIA ANN CLOUGH
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Credential | MS ATR LPC SAS
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Telephone | 414-429-6403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State | WI
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