OrganizationActive
Creative Change, LLC
NPI 1760515498 · Clinical Psychologist · Ellisville, MO
Provider details
- NPI number
- 1760515498
- Entity type
- Organization
- Primary specialty
- Clinical PsychologistBehavioral Health & Social Service Providers
- Organization subpart
- No
- Authorized official
- Rhonda Stewart, Billing Manager(636) 893-8949
Specialties & taxonomies
Behavioral Health & Social Service Providers
- Clinical Social Worker1041C0700X
Behavioral Health & Social Service Providers
- Professional Counselor101YP2500X
Behavioral Health & Social Service Providers
Profile Score
Detailed profile(94/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
2 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
177 Clarkson Executive Park
Ellisville, MO 63011-2176
Phone: (314) 962-7788
Street-level locationGet directions
Mailing address
177 Clarkson Executive Park
Ellisville, MO 63011-2176
Additional practice locations (1)
- 8772 Big Bend BlvdSaint Louis, MO 63119-3730Phone: (314) 962-7788Fax: (314) 962-4158
Registry dates
- Enumerated
- 2007-03-13
- Last updated
- 2025-09-17
- Certified
- 2025-09-17
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.