Provider Demographics
NPI:1174384812
Name:CREATIVE CARE COUNSELING, LLC
Entity type:Organization
Organization Name:CREATIVE CARE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HERGOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-230-7576
Mailing Address - Street 1:710 S. 13TH ST.
Mailing Address - Street 2:STE 900 PMB 216
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-5792
Mailing Address - Country:US
Mailing Address - Phone:402-230-7576
Mailing Address - Fax:402-226-4824
Practice Address - Street 1:802 CUSTER AVE STE B
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-0859
Practice Address - Country:US
Practice Address - Phone:402-230-7576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-19
Last Update Date:2024-02-21
Deactivation Date:2024-02-05
Deactivation Code:
Reactivation Date:2024-02-21
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty