Creative Counseling Centers, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

SW10736 Issued in FL

Legal business name

CREATIVE COUNSELING CENTERS, LLC

Practice address

3270 Suntree Blvd
Suite 2233
Melbourne, FL 32940-7530

Phone

(321) 615-0990

Fax

(888) 341-8272

NPI assigned

Aug 19, 2013

Organization subpart

No

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

Authorized official

Name

Ms. Gwen Ann Mundorf, L.C.S.W.NPI 1295967776

Title

Owner/Director

Phone

(321) 615-0990

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gwen Mundorf, MSW, LCSW

  • Clinical Social Worker
  • Melbourne, FL
  • NPI 1295967776
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1376870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406419200000",
    "number": "1376976829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5972 GOLETA CIR",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329408035",
            "telephone_number": "321-615-0990",
            "fax_number": "888-341-8272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3270 SUNTREE BLVD",
            "address_2": "SUITE 2233",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329407530",
            "telephone_number": "321-615-0990",
            "fax_number": "888-341-8272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREATIVE COUNSELING CENTERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-19",
        "last_updated": "2014-07-27",
        "status": "A",
        "authorized_official_last_name": "MUNDORF",
        "authorized_official_first_name": "GWEN",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "321-615-0990",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "L.C.S.W."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "FL",
            "license": "SW10736",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jamie Lynn Crawford, APRN
• Mary Crawford, DMD
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• Joe Morton Creel, D.D.S., M.S.
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• Laurel Anne Crespo, ARNP

• Community/Behavioral Health Agency in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Community/Behavioral Health Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2014; 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.