| Creative Change Therapy Center Llp | |
|
10702 Lombardy Rd Silver Spring MD 20901-1631 | |
| (301) 754-0122 | |
| Not Available |
| Full Name | Creative Change Therapy Center Llp |
|---|---|
| Speciality | Social Worker |
| Location | 10702 Lombardy Rd, Silver Spring, Maryland |
| Authorized Official Name and Position | Kent Robert Beduhn (PARTNER) |
| Authorized Official Contact | 3017540122 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Creative Change Therapy Center Llp 10702 Lombardy Rd Silver Spring MD 20901-1631 Ph: (301) 754-0122 | Creative Change Therapy Center Llp 10702 Lombardy Rd Silver Spring MD 20901-1631 Ph: (301) 754-0122 |
| NPI Number | 1982862405 |
|---|---|
| Provider Enumeration Date | 05/30/2008 |
| Last Update Date | 09/03/2009 |
| Medicare PECOS PAC ID | 8123173747 |
|---|---|
| Medicare Enrollment ID | O20090903000516 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982862405 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 4026 (Maryland) | Secondary |
| 1041C0700X | Social Worker - Clinical | 05659 (Maryland) | Primary |
| Provider Name | Patricia Bullard-bates |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1770551038 PECOS PAC ID: 6608822358 Enrollment ID: I20050324001065 |
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