Provider Demographics
NPI:1275300113
Name:CREATIVE LEARNING THERAPIES
Entity Type:Organization
Organization Name:CREATIVE LEARNING THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, BEHAVIOR ANALYST
Authorized Official - Prefix:MRS
Authorized Official - First Name:NYETTA
Authorized Official - Middle Name:SHANEE
Authorized Official - Last Name:ABERNATHY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:702-526-7541
Mailing Address - Street 1:3320 SALMON CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-6186
Mailing Address - Country:US
Mailing Address - Phone:702-526-7541
Mailing Address - Fax:
Practice Address - Street 1:3320 SALMON CREEK DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-6186
Practice Address - Country:US
Practice Address - Phone:702-526-7541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty