| Creative Healing Art Therapy, Pllc | |
|
200 W Monroe St Ste C7 Bloomington IL 61701-3997 | |
| (309) 287-0610 | |
| Not Available |
| Full Name | Creative Healing Art Therapy, Pllc |
|---|---|
| Speciality | Counselor |
| Location | 200 W Monroe St Ste C7, Bloomington, Illinois |
| Authorized Official Name and Position | Karli Johnson (OWNER) |
| Authorized Official Contact | 3092870610 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Creative Healing Art Therapy, Pllc 200 W. Monroe St. Box 23 Bloomington IL 61701-3997 Ph: () - | Creative Healing Art Therapy, Pllc 200 W Monroe St Ste C7 Bloomington IL 61701-3997 Ph: (309) 287-0610 |
| NPI Number | 1295221984 |
|---|---|
| Provider Enumeration Date | 07/05/2018 |
| Last Update Date | 10/24/2023 |
| Certification Date | 10/24/2023 |
| Medicare PECOS PAC ID | 0547602658 |
|---|---|
| Medicare Enrollment ID | O20240521002404 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295221984 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 180011489 (Illinois) | Primary |
| Provider Name | Karli Johnson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1023525292 PECOS PAC ID: 1456793561 Enrollment ID: I20240521002610 |
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