NPIMap

Organization Active NPI

Createwellness LLC

  • Mental Health Counselor
  • Baltimore, MD
National Provider Identifier
1417602954
Registry record updated Jul 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
CREATEWELLNESS LLC
Practice address
1111 Park Ave
Baltimore, MD 21201-5656
Phone
(805) 570-8079
NPI assigned
Feb 14, 2022
Last updated
Jul 27, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2022

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

Authorized official

Name
Kalkidan ZeryihunNPI 1649651555
Title
Member
Phone
(805) 870-5709

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
Mental Health Counselor 101YM0800X NU Primary

Addresses

Primary practice location

1111 Park Ave
Baltimore, MD 21201-5656

Mailing address

1111 Park Ave #606
Baltimore, MD 21201-5612
Phone (805) 870-5709

National Provider Directory

National Provider Directory

Locations

1111 Park Ave
Baltimore, MD 21201
Phone (571) 342-9811

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": "1644796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658880000000",
    "number": "1417602954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 PARK AVE #606",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212015612",
            "telephone_number": "805-870-5709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 PARK AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212015656",
            "telephone_number": "805-570-8079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREATEWELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-14",
        "last_updated": "2022-07-27",
        "certification_date": "2022-07-27",
        "status": "A",
        "authorized_official_last_name": "ZERYIHUN",
        "authorized_official_first_name": "KALKIDAN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "805-870-5709"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2022; 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.