| Tw Creative Therapy, Llc | |
|
1121 E Mullan Ave Ste 210 Coeur D Alene ID 83814-4054 | |
| (208) 930-4003 | |
| (208) 930-4043 |
| Full Name | Tw Creative Therapy, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1121 E Mullan Ave Ste 210, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Tanya C Wenig (PROVIDER/OWNER) |
| Authorized Official Contact | 2089304003 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tw Creative Therapy, Llc 1121 E Mullan Ave Ste 210 Coeur D Alene ID 83814-4054 Ph: (208) 930-4003 | Tw Creative Therapy, Llc 1121 E Mullan Ave Ste 210 Coeur D Alene ID 83814-4054 Ph: (208) 930-4003 |
| NPI Number | 1710545413 |
|---|---|
| Provider Enumeration Date | 05/29/2019 |
| Last Update Date | 05/29/2019 |
| Medicare PECOS PAC ID | 0941651145 |
|---|---|
| Medicare Enrollment ID | O20240112000510 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710545413 | NPI | - | NPPES |
| 000588275003 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Tanya Wenig |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1194066696 PECOS PAC ID: 1850742057 Enrollment ID: I20240112000558 |
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