Provider Demographics
NPI:1063007722
Name:CREATIVE RESILIENCE THERAPY SERVICES LLC
Entity type:Organization
Organization Name:CREATIVE RESILIENCE THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HALENE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAYTES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CAADC
Authorized Official - Phone:517-648-3744
Mailing Address - Street 1:8005 MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-1027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8005 MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-1027
Practice Address - Country:US
Practice Address - Phone:734-489-9686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty