Provider Demographics
NPI:1073339305
Name:CREATIVELY CLINIC LLC
Entity type:Organization
Organization Name:CREATIVELY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HESSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-675-8083
Mailing Address - Street 1:999 BRICKELL AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3041
Mailing Address - Country:US
Mailing Address - Phone:786-659-5296
Mailing Address - Fax:
Practice Address - Street 1:8395 W OAKLAND PARK BLVD STE C
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7346
Practice Address - Country:US
Practice Address - Phone:786-659-5296
Practice Address - Fax:561-448-7160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental HealthGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty