MEDICARE: CREATIVE COUNSELING, INC

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1578612057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATIVE COUNSELING, INC

Provider Business Mailing Address
First Line	:	5168 VILLAGE CREEK DR STE 200
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4447
Country	:	US
Telephone Number	:	972-248-7722
Fax Number	:	972-248-7048

Provider Business Practice Location Address
First Line	:	5168 VILLAGE CREEK DR STE 200
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4447
Country	:	US
Telephone Number	:	972-248-7722
Fax Number	:	972-248-7048

Authorized Official
Title or Position	:	COUNSELOR
Name	:	KRIS E WHITE
Credential	:	LCSW
Telephone Number	:	972-248-7722

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	08/22/2020

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