Provider Demographics
NPI:1104032135
Name:CENTER FOR CREATIVE TRANSFORMATION
Entity Type:Organization
Organization Name:CENTER FOR CREATIVE TRANSFORMATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,, LMFT
Authorized Official - Phone:559-435-7835
Mailing Address - Street 1:5475 N. FRESNO STREET
Mailing Address - Street 2:SUITE 109
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-8333
Mailing Address - Country:US
Mailing Address - Phone:559-435-7835
Mailing Address - Fax:
Practice Address - Street 1:5475 N. FRESNO STREET
Practice Address - Street 2:SUITE 109
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8333
Practice Address - Country:US
Practice Address - Phone:559-435-7835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health