Provider Demographics
NPI:1740166495
Name:CREATIVE ROOTS COUNSELING
Entity type:Organization
Organization Name:CREATIVE ROOTS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, ATR
Authorized Official - Phone:920-948-3706
Mailing Address - Street 1:W5175 COUNTY ROAD Y
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54937-7783
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:N9450 MOHAWK RD STE 113
Practice Address - Street 2:
Practice Address - City:THERESA
Practice Address - State:WI
Practice Address - Zip Code:53091-9770
Practice Address - Country:US
Practice Address - Phone:920-948-3706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty