| Creative Change, LLC | |
|
177 Clarkson Executive Park Ellisville MO 63011-2176 | |
| (314) 962-7788 | |
| Not Available |
| Full Name | Creative Change, LLC |
|---|---|
| Speciality | Psychologist |
| Location | 177 Clarkson Executive Park, Ellisville, Missouri |
| Authorized Official Name and Position | Rhonda Stewart (BILLING MANAGER) |
| Authorized Official Contact | 6368938949 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Creative Change, LLC 177 Clarkson Executive Park Ellisville MO 63011-2176 Ph: (314) 962-7788 | Creative Change, LLC 177 Clarkson Executive Park Ellisville MO 63011-2176 Ph: (314) 962-7788 |
| NPI Number | 1760515498 |
|---|---|
| Provider Enumeration Date | 03/13/2007 |
| Last Update Date | 09/17/2025 |
| Certification Date | 09/17/2025 |
| Medicare PECOS PAC ID | 4082714092 |
|---|---|
| Medicare Enrollment ID | O20070705000115 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760515498 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (NU) | Secondary |
| 103TC0700X | Psychologist - Clinical | (NU) | Primary |
| 1041C0700X | Social Worker - Clinical | (NU) | Secondary |
| Provider Name | Robert S Rosen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265560734 PECOS PAC ID: 9830280163 Enrollment ID: I20070801000172 |
| Provider Name | Patricia M Boever |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1073568069 PECOS PAC ID: 0446350458 Enrollment ID: I20100721000160 |
| Provider Name | Timothy J Jovick |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1174620793 PECOS PAC ID: 5698809531 Enrollment ID: I20100814000135 |
| Provider Name | Michael ML Krownapple |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1568779189 PECOS PAC ID: 8820262330 Enrollment ID: I20111118000486 |
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