1922491919 NPI number — CREATIVE COUNSELING AND EVALUATION SERVICES, LLC

Table of content: MR. ALEXANDER EVAN GRAF MD (NPI 1275152753)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922491919 NPI number — CREATIVE COUNSELING AND EVALUATION SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CREATIVE COUNSELING AND EVALUATION SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922491919
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2835 BELVIDERE RD
Provider Second Line Business Mailing Address:
SUITE 214
Provider Business Mailing Address City Name:
WAUKEGAN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60085-6046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-672-9059
Provider Business Mailing Address Fax Number:
847-672-8237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2835 BELVIDERE RD
Provider Second Line Business Practice Location Address:
SUITE 214
Provider Business Practice Location Address City Name:
WAUKEGAN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60085-6046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-672-9059
Provider Business Practice Location Address Fax Number:
847-672-8237
Provider Enumeration Date:
03/14/2015

Additional Information

Authorized Official

Authorized Official Last Name:
VINSON-BOYER
Authorized Official First Name:
BECKY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
847-672-9059

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  248000668 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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