Organization
CREATIVE ALTERNATIVES FOR PSYCHOLOGICAL GROWTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY VINEHOUT PSYD (CLINICAL PSYCHOLOGIST)
(815) 245-6669
Entity
Organization
Contact information
Practice address
645 MCHENRY AVE, WOODSTOCK, IL 60098-2922
(815) 245-6669
Mailing address
PO BOX 1861, WOODSTOCK, IL 60098-1861
(815) 245-6669
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
071006683
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11894012
CAQH
IL
01
—
2201382
COMPSYCH
IL
01
—
35641736
BCBS
IL
01
—
600016110
MAGELLAN
IL
Enumeration date
07/10/2010
Last updated
09/14/2010
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