| Creative Storm Therapy, LLC | |
|
1111 55th St Ste 4 Kenosha WI 53140-3611 | |
| (262) 346-5913 | |
| Not Available |
| Full Name | Creative Storm Therapy, LLC |
|---|---|
| Speciality | Counselor |
| Location | 1111 55th St Ste 4, Kenosha, Wisconsin |
| Authorized Official Name and Position | Lori Storm (OWNER) |
| Authorized Official Contact | 2623465913 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Creative Storm Therapy, LLC 4308 Pennington Ln Mount Pleasant WI 53403-3960 Ph: (262) 346-5913 | Creative Storm Therapy, LLC 1111 55th St Ste 4 Kenosha WI 53140-3611 Ph: (262) 346-5913 |
| NPI Number | 1194442202 |
|---|---|
| Provider Enumeration Date | 10/20/2022 |
| Last Update Date | 10/20/2022 |
| Certification Date | 10/20/2022 |
| Medicare PECOS PAC ID | 4284131723 |
|---|---|
| Medicare Enrollment ID | O20251009001871 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194442202 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | () | Primary |
| Provider Name | Lori Storm |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1316480312 PECOS PAC ID: 5193222636 Enrollment ID: I20251009002016 |
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