Provider Demographics
NPI:1285060939
Name:CREATIVE COUNSELING CENTER
Entity type:Organization
Organization Name:CREATIVE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:KARJALA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT,LPC, RPT,CAC II
Authorized Official - Phone:303-843-6000
Mailing Address - Street 1:6021 S SYRACUSE WAY
Mailing Address - Street 2:STE. 216
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4730
Mailing Address - Country:US
Mailing Address - Phone:303-843-6000
Mailing Address - Fax:303-843-6001
Practice Address - Street 1:6021 S SYRACUSE WAY
Practice Address - Street 2:STE. 216
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4730
Practice Address - Country:US
Practice Address - Phone:303-843-6000
Practice Address - Fax:303-843-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0103419101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12452110OtherCAQH