Provider Demographics
NPI:1609196898
Name:THE CREATIVE THERAPY CENTER, LLC
Entity type:Organization
Organization Name:THE CREATIVE THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:RENEE-HAUSER
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT, RPT
Authorized Official - Phone:763-274-0510
Mailing Address - Street 1:657 MAIN ST NW STE 214
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1584
Mailing Address - Country:US
Mailing Address - Phone:763-274-0510
Mailing Address - Fax:
Practice Address - Street 1:815 HIGHWAY 10 STE 102
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-5204
Practice Address - Country:US
Practice Address - Phone:763-274-0510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health