Provider Demographics
NPI:1598999898
Name:CENTER FOR CREATIVE STUDIES INC.
Entity Type:Organization
Organization Name:CENTER FOR CREATIVE STUDIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:TACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LPAT
Authorized Official - Phone:505-255-8682
Mailing Address - Street 1:14109 GRAND AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-1802
Mailing Address - Country:US
Mailing Address - Phone:505-255-8682
Mailing Address - Fax:505-255-7890
Practice Address - Street 1:2741 INDIAN SCHOOL RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2653
Practice Address - Country:US
Practice Address - Phone:505-255-8682
Practice Address - Fax:505-255-7890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0085781101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty