Provider Demographics
NPI:1316691538
Name:CREATIVE MINDS COUNSELING
Entity type:Organization
Organization Name:CREATIVE MINDS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER, CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:PROSPAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-234-1378
Mailing Address - Street 1:75 MILFORD DR STE 103
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-2778
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 MILFORD DR STE 103
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-2778
Practice Address - Country:US
Practice Address - Phone:330-234-1378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health