Provider Demographics
NPI:1588535876
Name:CREEKSIDE COUNSELING GROUP
Entity type:Organization
Organization Name:CREEKSIDE COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:GRINGORTEN
Authorized Official - Suffix:
Authorized Official - Credentials:TLLP
Authorized Official - Phone:248-761-4059
Mailing Address - Street 1:13308 TALBOT AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1025
Mailing Address - Country:US
Mailing Address - Phone:248-761-4059
Mailing Address - Fax:
Practice Address - Street 1:10801 S SAGINAW ST STE D
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8126
Practice Address - Country:US
Practice Address - Phone:810-771-4074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty