Basic Information
| Provider Information | |||||||||
| NPI: | 1902336365 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INSPIRED CREATIVE SOLUTIONS THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 240 LENOX BRG | ||||||||
| Address2: | |||||||||
| City: | STERLINGTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712803346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185374397 | ||||||||
| FaxNumber: | 3183258749 | ||||||||
| Practice Location | |||||||||
| Address1: | 908 N 3RD ST | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712015844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185374397 | ||||||||
| FaxNumber: | 3183258749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2017 | ||||||||
| LastUpdateDate: | 11/27/2017 | ||||||||
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| AuthorizedOfficialLastName: | HAMILTON | ||||||||
| AuthorizedOfficialFirstName: | LATRICE | ||||||||
| AuthorizedOfficialMiddleName: | LANETTE | ||||||||
| AuthorizedOfficialTitleorPosition: | LICENSED PROFESSIONAL COUNSLEOR | ||||||||
| AuthorizedOfficialTelephone: | 3185374397 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 5828 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.