CREATIVE CHANGE, LLC (NPI# 1760515498) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760515498 |
| Entity Type | Organization |
| Organization Name | CREATIVE CHANGE, LLC |
| Practice Address |
8772 Big Bend Blvd Saint Louis MO 63119-3730 |
| Practice Telephone | 3149627788 |
| Practice Fax Number | 3149624158 |
| Mailing Telephone | 3149627788 |
| Mailing Fax Number | 3149624158 |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DORIS BENDER (MANAGED CARE COORDINATOR) |
| Authorized Official Telephone | 3149627788 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 101YP2500X |
Counselor Specialization: Professional |
Behavioral Health & Social Service Providers | ||
| X | 103TC0700X |
Psychologist Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| X | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers |
| Street Address |
8772 BIG BEND BLVD |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63119-3730 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073568069 | Patricia M. Boever | Psychologist | 8772 Big Bend Blvd, Saint Louis, MO 63119-3730 | 2006-05-24 |
| 1104285246 | Patricia Ann Ferrugia | Social Worker | 8772 Big Bend Blvd, Creative Change,llc, Saint Louis, MO 63119-3730 | 2016-02-17 |
| 1902038904 | Cathy Flynn | Social Worker | 8772 Big Bend Blvd, Saint Louis, MO 63119-3730 | 2009-08-10 |
| 1902976541 | Ellen Levitz | Psychologist | 8772 Big Bend Blvd, Saint Louis, MO 63119-3730 | 2006-11-09 |
| 1649340100 | Karen Yount | Counselor | 8772 Big Bend Blvd, Saint Louis, MO 63119-3730 | 2006-11-09 |
| 1174620793 | Timothy J. Jovick | Psychologist | 8772 Big Bend Blvd, Saint Louis, MO 63119-3730 | 2006-09-17 |
| 1578660106 | Lori E. Kiefer | Counselor | 8772 Big Bend Blvd, Saint Louis, MO 63119-3730 | 2006-09-17 |
| 1255438883 | Karol A. Kiel | Psychologist | 8772 Big Bend Blvd, Saint Louis, MO 63119-3730 | 2006-09-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114525631 | Kaylen A Howard | Specialist/Technologist | No, No, MO 63119 | 2020-10-16 |
| 1053887612 | St. Gianna Pediatrics, LLC | Pediatrics | 7387 Watson Road, Shrewsbury, MO 63119 | 2018-10-22 |
| 1982140265 | Forefront Dermatology, S.c. | Dermatology | 8567 Watson Rd, Webster Groves, MO 63119 | 2017-01-11 |
| 1407308018 | Tyler Clark | Student in an Organized Health Care Education/Training Program | 7785 Keswick Pl, Saint Louis, MO 63119 | 2016-10-30 |
| 1396109880 | Ritesh Gandhi | Family Medicine | 7345 Watson Rd Ste 203, Saint Louis, MO 63119 | 2016-04-11 |
| 1568834489 | Antonio Robinson | Counselor | 330 N. Gore, Great Circle, Saint Louis, MO 63119 | 2015-10-30 |
| 1922484039 | Odessa Baker X | Dietary Manager | 525 N. Laclede Station Road, St. Louis, MO 63119 | 2015-07-31 |
| 1194114694 | Laura Maher | Social Worker | 201 W. Lockwood Ave, Suite 201, St. Louis, MO 63119 | 2015-01-21 |
| 1427314046 | Dick (richard) Ralph Brummett | Family Medicine | 711 S Laclede Sta Rd, # 2111, St Louis, MO 63119 | 2012-04-09 |
| 1972872935 | Dolliene A. Raabe | Social Worker | 8050 Watson Road, Suite 201, St. Louis, MO 63119 | 2011-12-21 |
| Find all providers in zip 63119 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841899374 | Christopher Seigel | Counselor | 5317 Mild Dr, Saint Louis, MO 63129-3109 | 2020-10-26 |
| 1467067504 | Anne Margaret Perkins | Counselor | 9733 Saint Charles Rock Rd, Saint Louis, MO 63114-2625 | 2020-09-15 |
| 1730792722 | Aryn Bostic | Counselor | 7584 Olive Blvd Ste 203, Saint Louis, MO 63130-1600 | 2020-08-28 |
| 1417568932 | Child and Family Empowerment Center | Counselor | 800 N Tucker Blvd Fl 1, Saint Louis, MO 63101-1008 | 2020-08-10 |
| 1720603830 | Kelly Marie Buckley | Counselor | 5939 Hilgard Pl, Saint Louis, MO 63109-3445 | 2020-06-15 |
| 1407479207 | Lauren Elizabeth Summers | Counselor | 6261 Reber Pl, Saint Louis, MO 63139-2617 | 2020-05-27 |
| 1306469960 | Walter Robert Scull | Counselor | 1300 Kirkham Ave, Saint Louis, MO 63122-3127 | 2020-05-18 |
| 1982226759 | David Mcgraw | Counselor | 28 Reasor Dr, Saint Louis, MO 63135-1125 | 2020-05-14 |
| 1992326565 | Chantrell M Carter | Counselor | 5027 Mardel Ave, Saint Louis, MO 63109-1731 | 2020-05-05 |
| 1508486333 | Evelyn Aviva Witten | Counselor | 130 S Bemiston Ave Ste 604, Saint Louis, MO 63105-1913 | 2020-04-22 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63119 |
Please comment or provide details below to improve the information on CREATIVE CHANGE, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.