Organization
CREATIVE ONE STUDIO, INC.
Active
Other names
Creative One Counseling
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TRACY PUALANI TAKAKI BC-DMT, LCPC (PROFESSIONAL COUNSELOR)
(773) 318-7331
Entity
Organization
Contact information
Practice address
501 S HARVARD AVE, VILLA PARK, IL 60181-2808
(773) 318-7331
Mailing address
501 S HARVARD AVE, VILLA PARK, IL 60181-2808
(773) 318-7331
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
180006573
IL
Other
Enumeration date
02/04/2009
Last updated
04/11/2011
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