Provider Demographics
NPI:1578251724
Name:CREATIVE BEHAVIORAL CONNECTIONS LLC
Entity Type:Organization
Organization Name:CREATIVE BEHAVIORAL CONNECTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ DIRECTOR OF PSYCHOLOGICAL SERV
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:702-901-5200
Mailing Address - Street 1:5803 W CRAIG RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-2537
Mailing Address - Country:US
Mailing Address - Phone:702-901-5200
Mailing Address - Fax:702-901-5201
Practice Address - Street 1:5803 W CRAIG RD STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2537
Practice Address - Country:US
Practice Address - Phone:702-901-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health