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NPI Code Detail

MEDICARE: CREATING CONNECTIONS COUNSELING SERVICES PLLC

MEDICARE: CREATING CONNECTIONS COUNSELING SERVICES PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1174131569
Entity Type Code : Organization
Provider Name (Legal Business Name) : CREATING CONNECTIONS COUNSELING SERVICES PLLC
Provider Business Mailing Address
First Line : 13810 CHAMPION FOREST DR STE 150
Second Line :
City : HOUSTON
State : TX
Zip : 77069-1883
Country : US
Telephone Number : 832-639-8080
Fax Number :
Provider Business Practice Location Address
First Line : 13810 CHAMPION FOREST DR STE 150
Second Line :
City : HOUSTON
State : TX
Zip : 77069-1883
Country : US
Telephone Number : 832-639-8080
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DORETHA PENGEL
Credential : LCSW
Telephone Number : 832-639-8080
Provider Enumeration Date : 07/21/2020
Last Update Date : 03/22/2026

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Directions to “CREATING CONNECTIONS COUNSELING SERVICES PLLC ” Practice Location

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