Provider Demographics
NPI:1992538144
Name:CREATIVE MINDS COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:CREATIVE MINDS COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IVORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXWELL-HEDGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:214-490-9641
Mailing Address - Street 1:106 E OVILLA RD STE 1A-160
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-2479
Mailing Address - Country:US
Mailing Address - Phone:469-552-5389
Mailing Address - Fax:
Practice Address - Street 1:106 E OVILLA RD STE 1A-160
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-2479
Practice Address - Country:US
Practice Address - Phone:469-552-5389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-22
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)