Provider Demographics
NPI:1023643947
Name:CREATIVE CHANGE COUNSELING
Entity type:Organization
Organization Name:CREATIVE CHANGE COUNSELING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-772-0226
Mailing Address - Street 1:10504 BRUTON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-3105
Mailing Address - Country:US
Mailing Address - Phone:214-772-0226
Mailing Address - Fax:972-767-3471
Practice Address - Street 1:10504 BRUTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-3105
Practice Address - Country:US
Practice Address - Phone:214-772-0226
Practice Address - Fax:972-767-3471
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CL COUNSELING PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-11
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health