CREATIVE RENEWAL & RESOLUTIONS, LLC (NPI# 1184915472) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184915472 |
| Entity Type | Organization |
| Organization Name | CREATIVE RENEWAL & RESOLUTIONS, LLC |
| Other Organization Name | CREATIVE RENEWAL & RESOLUTIONS |
| Practice Address |
1531 E Bradford Pkwy Ste 210-4 Springfield MO 65804-6566 |
| Practice Telephone | 4178904083 |
| Practice Fax Number | 4178904091 |
| Mailing Telephone | 4178904083 |
| Mailing Fax Number | 4178904091 |
| Enumeration Date | 2011-04-21 |
| Last Update Date | 2011-04-21 |
| Authorized Official Name | DR. DAVID L BLACK (OWNER, MANAGING MEMBER) |
| Authorized Official Telephone | 4178904083 |
| Authorized Official Credential | PSYD, LCSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TA0400X |
Psychologist Specialization: Addiction (Substance Use Disorder) |
2009026793 | MO | Behavioral Health & Social Service Providers |
| N | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
2009026793 | MO | Behavioral Health & Social Service Providers |
| N | 103TC0700X |
Psychologist Specialization: Clinical |
2009026793 | MO | Behavioral Health & Social Service Providers |
| N | 103TC1900X |
Psychologist Specialization: Counseling |
2009026793 | MO | Behavioral Health & Social Service Providers |
| N | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
2009026793 | MO | Behavioral Health & Social Service Providers |
| N | 103TP2701X |
Psychologist Specialization: Group Psychotherapy |
2009026793 | MO | Behavioral Health & Social Service Providers |
| N | 1041C0700X |
Social Worker Specialization: Clinical |
2001004284 | MO | Behavioral Health & Social Service Providers |
| N | 106H00000X | Marriage & Family Therapist | 2001004284 | MO | Behavioral Health & Social Service Providers |
| Y | 103TH0100X |
Psychologist Specialization: Health Service |
2009026793 | MO | Behavioral Health & Social Service Providers |
| Other Name | Type Code |
|---|---|
| Creative Renewal & Resolutions | Doing Business As Name - Organization |
| Street Address |
1531 E BRADFORD PKWY STE 210-4 |
| City | SPRINGFIELD |
| State | MO |
| Zip Code | 65804-6566 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588667208 | Bradford Place Surgery and Laser Center LLC | Clinic/Center | 1531 E Bradford Pkwy, Ste 120, Springfield, MO 65804-6539 | 2005-05-27 |
| 1114292919 | Kimberly Ann Ramacciotti | Counselor | 1531 E Bradford Pkwy, Suite 304, Springfield, MO 65804-6566 | 2012-03-13 |
| 1033427810 | Renae Marie Courtney | Psychologist | 1531 E Bradford Pkwy, Suite 304, Springfield, MO 65804-6566 | 2010-09-15 |
| 1760793483 | Diderika M Telting | Speech-Language Pathologist | 1531 E Bradford Pkwy, Suite 205, Springfield, MO 65804-6853 | 2010-06-28 |
| 1336300466 | Reynolds Plastic Surgery LLC | Specialist | 1531 E Bradford Pkwy, Suite 215, Springfield, MO 65804-6566 | 2008-06-20 |
| 1801097951 | N Eugene Morrow Md LLC | Dermatology | 1531 E Bradford Pkwy, Suite 215, Springfield, MO 65804-6539 | 2007-05-29 |
| 1144277252 | Missouri Eye Institute LLC | Optometrist | 1531 E Bradford Pkwy, Suite 100, Springfield, MO 65804-6566 | 2006-05-27 |
| 1568433886 | Kathleen F Lemon | Psychologist | 1531 E Bradford Pkwy, Ste 210-1, Springfield, MO 65804-6856 | 2006-01-27 |
| 1184695496 | Ginger A Holczer | Psychologist | 1531 E Bradford Pkwy, Suite 202, Springfield, MO 65804-6566 | 2006-01-27 |
| 1093701211 | Daniel R Osborn | Ophthalmology | 1531 E Bradford Pkwy, Suite 100, Springfield, MO 65804-6566 | 2005-09-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790393049 | Kathy Forson | Nurse Practitioner | 1235 E. Cherokee St., Springfield, MO 65804 | 2020-07-22 |
| 1306498779 | Anne B Summers, LLC | Social Worker | 1310 E. Kingsley St., Ste C, Springfield, MO 65804 | 2019-07-15 |
| 1790241800 | Margaret Mary Hart | Social Worker | 1845 S Rogers Ave, Springfield, MO 65804 | 2019-02-13 |
| 1598254666 | Casey Carr | Optometrist | 1229 E Seminole St Ste 110, Springfield, MO 65804 | 2018-05-04 |
| 1124520697 | Shelby D White | Behavioral Analyst | 1300 E. Bradford Parkway, Springfield, MO 65804 | 2018-03-01 |
| 1316448343 | Karl Lynham | Massage Therapist | 1200 E Woodhurst Dr R300, Springfield, MO 65804 | 2018-02-25 |
| 1699273763 | Leah Wilson | Counselor | 1322 E Woodgate, Springfield, MO 65804 | 2018-01-24 |
| 1295242626 | Matthew Crisp | Physical Therapist | 3252 E Independence St, Springfield, MO 65804 | 2018-01-08 |
| 1518491042 | Crystal Spangler | Dietitian, Registered | 1965 S Fremont Ave Ste 220, Springfield, MO 65804 | 2017-04-11 |
| 1588012033 | Jeffrey Williams | Pharmacist | 1235 E. Cherokee, Springfield, MO 65804 | 2016-05-25 |
| Find all providers in zip 65804 | ||||
| Taxonomy Code | 103TH0100X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Health Service |
| A psychologist, certified/licensed at the independent practice level in his/her state, who is duly trained and experienced in the delivery of direct, preventative, assessment, and therapeutic intervention services to individuals whose growth, adjustment, or functioning is actually impaired or is demonstrably at high risk of impairment (1974). |
| Notes: Source: National Register of Health Service Providers in Psychology website http://www.nationalregister.org/about_NR.html [7/1/2006: modified title, added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316458441 | Psych Associates LLC | Psychologist | 1358 E Kingsley St Ste E, Springfield, MO 65804 | 2017-10-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972117240 | Sherri Marie Mccray | Psychologist | 4 Florence Hill Ct, Black Jack, MO 63033-7230 | 2020-09-03 |
| 1740844844 | Shantiela Hall | Psychologist | 1238 Oxford Hill Ct Apt 9, Saint Louis, MO 63146-5721 | 2019-04-24 |
| 1073045340 | Iesha Joseph | Psychologist | 7251 Olive Blvd, Saint Louis, MO 63130-2322 | 2017-03-28 |
| 1346647906 | Emona Lashelle Ewharekuko | Psychologist | 2162 Cherry Ave, Saint Louis, MO 63121-5625 | 2014-11-25 |
| 1164680237 | Rumi Kato Price | Psychologist | Cid Bldg Washington University School of Medicine, Dept of Psychiatry, St Louis, MO 63110 | 2008-05-27 |
| 1083813869 | Kathleen M. Baggett | Psychologist | 5125 Tracy Ave, Kansas City, MO 64110-2515 | 2007-07-12 |
| 1790707123 | Paul Lynn Susic | Psychologist | 2451 Executive Dr. Ste. 103, St. Charles, MO 63303 | 2006-07-24 |
| 1912567322 | Christopher Poitevien | Psychologist | 1 Childrens Pl Ste 3n-14, Saint Louis, MO 63110-1002 | 2019-06-18 |
| 1285810432 | New Beginnings Behavioral Health | Psychologist | 729 W Center Cir, Suite 103, Nixa, MO 65714-7001 | 2008-01-18 |
| 1639353915 | Psychological Consultants PC | Psychologist | 6405 N Cosby Ave, Suite 203, Kansas City, MO 64151-2378 | 2007-12-22 |
| Find all providers with the same taxonomy | ||||
| City | SPRINGFIELD |
| Zip Code | 65804 |
Please comment or provide details below to improve the information on CREATIVE RENEWAL & RESOLUTIONS, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.