Organization Name: | THE CREATIVE COUNSELING GROUP |
NPI Number: | 1114302684 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DONALD C MATTSON (OWNER) |
Mailing Address: | 3215 Tower Ave Suite 108 Superior |
State: | WI US |
Postal Code: | 548805388 |
Phone Number: | 9063701668 |
Fax Number: | |
NPI Enumeration Date: | 07/27/2015 |
NPI Last Update Date: | 07/27/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 5340 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |