Provider Demographics
NPI:1124477963
Name:CO-CREATIVE COACHING, LLC
Entity type:Organization
Organization Name:CO-CREATIVE COACHING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MMGR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANUS
Authorized Official - Middle Name:
Authorized Official - Last Name:MONCUR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-285-2052
Mailing Address - Street 1:13900 JOG RD STE 262
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-5905
Mailing Address - Country:US
Mailing Address - Phone:561-285-2052
Mailing Address - Fax:
Practice Address - Street 1:660 LINTON BLVD
Practice Address - Street 2:203-A
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-8167
Practice Address - Country:US
Practice Address - Phone:561-285-2052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-11
Last Update Date:2016-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW13546101YA0400X, 101YM0800X, 101YP2500X, 102L00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Multi-Specialty