NPIMap

Organization Active NPI

Creative Change Counseling

  • Substance Abuse Rehabilitation Facility
  • Lumberton, NJ
National Provider Identifier
1235795014
Registry record updated May 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
CREATIVE CHANGE COUNSELING
Practice address
774 Eayrestown Rd Ste 204
Lumberton, NJ 08048-3100
Phone
(609) 668-4719
Fax
(609) 667-7944
NPI assigned
May 16, 2019
Last updated
May 16, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2019

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

Authorized official

Name
Bertee Thomas Jr., PSY.D.NPI 1649627431
Title
Ceo
Phone
(609) 667-7353

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

774 Eayrestown Rd Ste 204
Lumberton, NJ 08048-3100

Mailing address

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211011000372 NJ Part B Supplier - Clinic/Group Practice 9739587486 Receives reassigned benefits from 4 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lumberton, NJ; Southampton, NJ; Lakewood, NJ

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1557964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557964800000",
    "number": "1235795014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "774 EAYRESTOWN RD STE 204",
            "city": "LUMBERTON",
            "state": "NJ",
            "postal_code": "080483100",
            "telephone_number": "609-668-4719",
            "fax_number": "609-667-7944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "774 EAYRESTOWN RD STE 204",
            "city": "LUMBERTON",
            "state": "NJ",
            "postal_code": "080483100",
            "telephone_number": "609-668-4719",
            "fax_number": "609-667-7944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREATIVE CHANGE COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-16",
        "last_updated": "2019-05-16",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "BERTEE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "609-667-7353",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lumberton, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2019; 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.