Organization
TW CREATIVE THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANYA C WENIG LCPC (PROVIDER/OWNER)
(208) 930-4003
Entity
Organization
Contact information
Practice address
1121 E MULLAN AVE STE 210, COEUR D ALENE, ID 83814-4054
(208) 930-4003
(208) 930-4043
Mailing address
1121 E MULLAN AVE STE 210, COEUR D ALENE, ID 83814-4054
(208) 930-4003
(208) 930-4043
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000588275003
—
ID
Enumeration date
05/29/2019
Last updated
05/29/2019
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