MEDICARE: CREATIVE MENTAL HEALTH, LLC

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	101YP2500X	Professional Counselor	CP0006	NV
2	101Y00000X	Counselor	CP0006	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932499753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATIVE MENTAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	2852 KINKNOCKIE WAY
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89044-0250
Country	:	US
Telephone Number	:	702-499-3456
Fax Number	:	702-946-0830

Provider Business Practice Location Address
First Line	:	701 N GREEN VALLEY PKWY
Second Line	:	SUITE 200
City	:	HENDERSON
State	:	NV
Zip	:	89074-6177
Country	:	US
Telephone Number	:	702-499-3456
Fax Number	:	702-946-0830

Authorized Official
Title or Position	:	OWNER
Name	:	ELEN MICHELE SPROLE
Credential	:	LCPC
Telephone Number	:	702-499-3456

Provider Enumeration Date	:	04/13/2011
Last Update Date	:	04/13/2011

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