Organization
CREATIVE MINDS TX LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAZZAMIN CLARK LIFE COACH (OWNER)
(702) 354-1794
Entity
Organization
Contact information
Practice address
7441 MARVIN D LOVE FWY, DALLAS, TX 75237-3490
(469) 491-4911
Mailing address
7441 MARVIN D LOVE FWY, DALLAS, TX 75237-3490
(469) 491-4911
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
106S00000X
Behavior Technician
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
01/17/2024
Last updated
11/18/2024
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