Provider Demographics
NPI:1639666837
Name:CREATIVE WELLNESS INSTITUTE
Entity Type:Organization
Organization Name:CREATIVE WELLNESS INSTITUTE
Other - Org Name:CREATIVE WELLNESS INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CECCILY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDNASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-299-4679
Mailing Address - Street 1:4001 DON TOMASO DR APT 1
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-5319
Mailing Address - Country:US
Mailing Address - Phone:602-299-4679
Mailing Address - Fax:
Practice Address - Street 1:1713 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1611
Practice Address - Country:US
Practice Address - Phone:602-299-4679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation