Organization
CREATIVE CHANGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RHONDA STEWART (BILLING MANAGER)
(636) 893-8949
Entity
Organization
Contact information
Practice address
177 CLARKSON EXECUTIVE PARK, ELLISVILLE, MO 63011-2176
(314) 962-7788
Mailing address
177 CLARKSON EXECUTIVE PARK, ELLISVILLE, MO 63011-2176
(314) 962-7788
(314) 962-4158
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
03/13/2007
Last updated
09/17/2025
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