NPIMap

Organization Active NPI

Creative Change Counseling

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Hickory, NC
National Provider Identifier
1053794065
Registry record updated May 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
CREATIVE CHANGE COUNSELING
Practice address
423 7TH Ave SW
Hickory, NC 28602-3237
Phone
(609) 668-4719
NPI assigned
Jul 8, 2015
Last updated
May 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Bertee ThomasNPI 1649627431
Title
Program Operations Executive Direct
Phone
(609) 668-4719

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NJ Primary
Counseling Psychologist 103TC1900X NJ
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

423 7TH Ave SW
Hickory, NC 28602-3237

Mailing address

774 Eayrestown Rd
Suite 204
Lumberton, NJ 08048-3100
Phone (609) 668-4719

Other practice location 1

668 Main St Ste 204
Lumberton, NJ 08048-5016
Phone (609) 668-4719

Other identifiers 2

IdentifierTypeStateIssuer
0506460MedicaidNJ
1053794065MedicaidNC

Electronic endpoints 4

TypeEndpointUseAffiliation
CONNECT URL bthomas@creativechangeinc.org Direct
Other URL bthomas@creativechangeinc.org Direct
FHIR URL bthomas@creativechangeinc.org Direct
Direct Messaging Address bthomas@creativechangeinc.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240202001434 NC Part B Supplier - Clinic/Group Practice 9739587486 Receives reassigned benefits from 1 practitioner
Practice locations: Hickory, NC

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Creative Change Counseling14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Locations

668 Main St
Ste 204
Lumberton, NJ 08048

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1436313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652572800000",
    "number": "1053794065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "774 EAYRESTOWN RD",
            "address_2": "SUITE 204",
            "city": "LUMBERTON",
            "state": "NJ",
            "postal_code": "080483100",
            "telephone_number": "609-668-4719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "423 7TH AVE SW",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286023237",
            "telephone_number": "609-668-4719"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "668 Main St Ste 204",
            "address_purpose": "LOCATION",
            "city": "Lumberton",
            "state": "NJ",
            "postal_code": "080485016",
            "country_code": "US",
            "telephone_number": "609-668-4719",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CREATIVE CHANGE COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-08",
        "last_updated": "2022-05-15",
        "certification_date": "2022-05-15",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "BERTEE",
        "authorized_official_title_or_position": "PROGRAM OPERATIONS EXECUTIVE DIRECT",
        "authorized_official_telephone_number": "609-668-4719"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NJ",
            "license": null,
            "primary": true
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "NJ",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0506460",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053794065",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "bthomas@creativechangeinc.org",
            "affiliation": "N",
            "endpointDescription": "e-mail",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "668 Main St Ste 204",
            "city": "Lumberton",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080485016",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "bthomas@creativechangeinc.org",
            "affiliation": "N",
            "endpointDescription": "e-mail",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "423 7th Ave SW",
            "city": "Hickory",
            "state": "NC",
            "country_code": "US",
            "postal_code": "286023237",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "bthomas@creativechangeinc.org",
            "affiliation": "N",
            "endpointDescription": "e-mail",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "bthomas@creativechangeinc.org",
            "address_1": "423 7th Ave SW",
            "city": "Hickory",
            "state": "NC",
            "country_code": "US",
            "postal_code": "286023237",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bthomas@creativechangeinc.org",
            "affiliation": "N",
            "endpointDescription": "e-mail",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "bthomas@creativechangeinc.org",
            "address_1": "423 7th Ave SW",
            "city": "Hickory",
            "state": "NC",
            "country_code": "US",
            "postal_code": "286023237",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hickory, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.