Provider Demographics
NPI:1245580216
Name:CREATIVE KIDS BEHAVIORAL CONSULTING
Entity Type:Organization
Organization Name:CREATIVE KIDS BEHAVIORAL CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CORRINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-559-6678
Mailing Address - Street 1:6660 DELMONICO DR STE D214
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1899
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:408 W ROCKRIMMON BLVD UNIT A
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1738
Practice Address - Country:US
Practice Address - Phone:414-559-6678
Practice Address - Fax:719-213-2098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-17
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty