Provider Demographics
NPI:1679719652
Name:CREATIVE PSYCHOLOGICAL SOLUTIONS LLC
Entity type:Organization
Organization Name:CREATIVE PSYCHOLOGICAL SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:815-355-4292
Mailing Address - Street 1:104 W MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60112-4226
Mailing Address - Country:US
Mailing Address - Phone:815-355-4292
Mailing Address - Fax:815-356-7139
Practice Address - Street 1:350 E CONGRESS PKWY
Practice Address - Street 2:SUITE L
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6284
Practice Address - Country:US
Practice Address - Phone:815-355-4292
Practice Address - Fax:815-356-7139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-006447103T00000X
TX3-1970103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty