Organization
CREATIVE MIND THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES ALLEN COUGHLIN (OWNER)
(630) 561-5826
Entity
Organization
Contact information
Practice address
522 PASEO DEL PUEBLO NORTE, TAOS, NM 87571-5999
(630) 561-5826
Mailing address
3401 W REDFIELD RD, PHOENIX, AZ 85053-5642
(630) 561-5826
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
02/05/2024
Last updated
06/06/2024
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