Creative Renewal & Resolutions, LLC

Primary specialty

Health Service PsychologistTaxonomy code 103TH0100X

License

2009026793 Issued in MO

Legal business name

CREATIVE RENEWAL & RESOLUTIONS, LLC

Doing business as

Creative Renewal & Resolutions

Practice address

1531 E Bradford Pkwy
Ste 210-4
Springfield, MO 65804-6566

Phone

(417) 890-4083

Fax

(417) 890-4091

NPI assigned

Apr 21, 2011

Organization subpart

No

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

Authorized official

Name

Dr. David L Black, PSYD, LCSW

Title

Owner, Managing Member

Phone

(417) 890-4083

Specialties & licenses 9

Addresses

Other names 1

• Creative Renewal & Resolutions Doing business as

Locations

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

{
    "created_epoch": "1303344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303344000000",
    "number": "1184915472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1531 E BRADFORD PKWY",
            "address_2": "STE 210-4",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658046566",
            "telephone_number": "417-890-4083",
            "fax_number": "417-890-4091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1531 E BRADFORD PKWY",
            "address_2": "STE 210-4",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658046566",
            "telephone_number": "417-890-4083",
            "fax_number": "417-890-4091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREATIVE RENEWAL & RESOLUTIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-21",
        "last_updated": "2011-04-21",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER, MANAGING MEMBER",
        "authorized_official_telephone_number": "417-890-4083",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD, LCSW"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "MO",
            "license": "2009026793",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "MO",
            "license": "2009026793",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "2009026793",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": "MO",
            "license": "2009026793",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MO",
            "license": "2009026793",
            "primary": false
        },
        {
            "code": "103TH0100X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Health Service",
            "state": "MO",
            "license": "2009026793",
            "primary": true
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "MO",
            "license": "2009026793",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2001004284",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "MO",
            "license": "2001004284",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Creative Renewal & Resolutions",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Robin Jewell Craycroft, MS
• Jamie Crayton, PHARMD
• Kimberly M Creach, M.D.
• Creative Collaborative Therapy LLC
• Creative Counseling Center
• Sophia Grace Creeden, STUDENT
• Hannah Shirley Creek, PA-C
• Creekside at Elfindale
• Chelsea Crespo, PA
• Lisa Crick

• Health Service Psychologist in Springfield, MO
• Providers in Springfield, MO by specialty
• Health Service Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.