Provider Demographics
NPI:1114782752
Name:CREATIVE LIFE THERAPY LLC
Entity type:Organization
Organization Name:CREATIVE LIFE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:734-707-8420
Mailing Address - Street 1:8441 PAWNEE TRL
Mailing Address - Street 2:
Mailing Address - City:PINCKNEY
Mailing Address - State:MI
Mailing Address - Zip Code:48169-9391
Mailing Address - Country:US
Mailing Address - Phone:734-707-8420
Mailing Address - Fax:
Practice Address - Street 1:2350 WASHTENAW AVE STE 2
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4525
Practice Address - Country:US
Practice Address - Phone:734-707-8420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty