Provider Demographics
NPI:1417577842
Name:CREATIVE SOLUTIONS GROUP TRAUMA SERVICES LLC
Entity type:Organization
Organization Name:CREATIVE SOLUTIONS GROUP TRAUMA SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DORNER-ZUPANCIC
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:719-822-1495
Mailing Address - Street 1:20370 DRENNAN RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80928-9514
Mailing Address - Country:US
Mailing Address - Phone:719-822-1495
Mailing Address - Fax:719-960-2766
Practice Address - Street 1:14960 WOODCARVER RD STE 101
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-2370
Practice Address - Country:US
Practice Address - Phone:719-822-1495
Practice Address - Fax:719-960-2766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-27
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000149376Medicaid