Organization
CREATIVE ALTERNATIVES FOR PSYCHOLOGICAL GROWTH
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
101YP2500X
Professional Counselor
180-006526
IL
103TC0700X
Clinical Psychologist
071-006683
IL
251S00000X
Community/Behavioral Health Agency
Primary
071-006683
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05632205
BCBS
IL
01
—
600016119
MAGELLAN
IL
01
—
600244182
MAGELLAN
IL
Enumeration date
03/05/2007
Last updated
06/30/2010
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