| Creative Counseling Centers, Llc | |
|
3270 Suntree Blvd Suite 2233 Melbourne FL 32940-7530 | |
| (321) 615-0990 | |
| (888) 341-8272 |
| Full Name | Creative Counseling Centers, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 3270 Suntree Blvd, Melbourne, Florida |
| Authorized Official Name and Position | Gwen Ann Mundorf (OWNER/DIRECTOR) |
| Authorized Official Contact | 3216150990 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Creative Counseling Centers, Llc 5972 Goleta Cir Melbourne FL 32940-8035 Ph: (321) 615-0990 | Creative Counseling Centers, Llc 3270 Suntree Blvd Suite 2233 Melbourne FL 32940-7530 Ph: (321) 615-0990 |
| NPI Number | 1376976829 |
|---|---|
| Provider Enumeration Date | 08/19/2013 |
| Last Update Date | 07/27/2014 |
| Medicare PECOS PAC ID | 6608006283 |
|---|---|
| Medicare Enrollment ID | O20140226001980 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376976829 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | SW10736 (Florida) | Primary |
| Provider Name | Gwen A Mundorf |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295967776 PECOS PAC ID: 1052541638 Enrollment ID: I20140226002051 |
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