Provider Demographics
NPI:1396559027
Name:CREATING SPACE LLC
Entity type:Organization
Organization Name:CREATING SPACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:N
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:406-590-4792
Mailing Address - Street 1:4371 DEVERAUX PL UNIT A
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-5334
Mailing Address - Country:US
Mailing Address - Phone:406-590-4792
Mailing Address - Fax:
Practice Address - Street 1:4371 DEVERAUX PL UNIT A
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-5334
Practice Address - Country:US
Practice Address - Phone:406-590-4792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty