Provider Demographics
NPI:1215067608
Name:NEW CREATION PSYCHOLOGICAL SERVIES
Entity type:Organization
Organization Name:NEW CREATION PSYCHOLOGICAL SERVIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:COLLEEN
Authorized Official - Last Name:BALDUS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:231-652-1299
Mailing Address - Street 1:7800 S RIVER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEWAYGO
Mailing Address - State:MI
Mailing Address - Zip Code:49337-9752
Mailing Address - Country:US
Mailing Address - Phone:231-652-1299
Mailing Address - Fax:
Practice Address - Street 1:17635 PEARL ST
Practice Address - Street 2:
Practice Address - City:BAILEY
Practice Address - State:MI
Practice Address - Zip Code:49303-9750
Practice Address - Country:US
Practice Address - Phone:231-343-7969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011963103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty