Provider Demographics
NPI:1871986828
Name:CREATIVE HEALING ARTS & COUNSELING LLC
Entity type:Organization
Organization Name:CREATIVE HEALING ARTS & COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MS ATR LPC SAS
Authorized Official - Phone:414-429-6403
Mailing Address - Street 1:1085 REVERE DR
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4422
Mailing Address - Country:US
Mailing Address - Phone:414-429-6403
Mailing Address - Fax:
Practice Address - Street 1:418 E WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-3040
Practice Address - Country:US
Practice Address - Phone:414-429-6403
Practice Address - Fax:262-354-0791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-16
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty