MEDICARE: CREATIVE COMPASS AND COLLABORATIVE THERAPY

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
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1558290858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATIVE COMPASS AND COLLABORATIVE THERAPY

Provider Business Mailing Address
First Line	:	308 CLEVELAND AVE STE 303
Second Line	:
City	:	ISHPEMING
State	:	MI
Zip	:	49849-1842
Country	:	US
Telephone Number	:	906-204-2069
Fax Number	:	906-451-5455

Provider Business Practice Location Address
First Line	:	308 CLEVELAND AVE STE 303
Second Line	:
City	:	ISHPEMING
State	:	MI
Zip	:	49849-1842
Country	:	US
Telephone Number	:	906-204-2069
Fax Number	:	906-451-5455

Authorized Official
Title or Position	:	OWNER
Name	:	NICHOLE K NELSON
Credential	:	LMSW, CAADC
Telephone Number	:	906-204-2069

Provider Enumeration Date	:	05/14/2026
Last Update Date	:	05/14/2026

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