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General NPI Number Information
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NPI Number | 1992160899
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Entity Type | Organization
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Legal Business Name | CREATIVE COUNSELING CHOICES
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Dates
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Enumeration Date | 12/18/2015
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Last Update Date | 12/18/2015
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Provider Practice Location Address
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Address Line | 2092 S CUSTER RD 2092 S CUSTER RD
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City | MONROE
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State | MI
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Zip | 48161-1831
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Country | US
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Telephone | 734-457-2161
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Fax | 734-457-4146
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Provider Business Mailing Address
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Address Line | 2092 S CUSTER RD 2092 S CUSTER RD
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City | MONROE
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State | MI
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Zip | 48161-1831
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Country | US
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Telephone | 734-457-2161
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Fax | 734-457-4146
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | STEPHANIE BEAUBIEN
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Credential |
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Telephone | 734-457-2161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6801088306
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License Number State | MI
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