Provider Demographics
NPI:1730517129
Name:CREATIVE COUNSELING CENTER
Entity type:Organization
Organization Name:CREATIVE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFF
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:715-456-1741
Mailing Address - Street 1:13835 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-5028
Mailing Address - Country:US
Mailing Address - Phone:715-456-1741
Mailing Address - Fax:
Practice Address - Street 1:13835 39TH AVE
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-5028
Practice Address - Country:US
Practice Address - Phone:715-456-1741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3241251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management