Organization Name: | CREATIVE ROOTS THERAPY LLC |
NPI Number: | 1144607961 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ERIN ELIZABETH SPIER (OWNER/THERAPIST) |
Mailing Address: | 375 Park Ave Suite B Coos Bay |
State: | OR US |
Postal Code: | 97420 |
Phone Number: | 5418084719 |
Fax Number: | |
NPI Enumeration Date: | 04/30/2015 |
NPI Last Update Date: | 07/18/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | C3450 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |