Provider Demographics
NPI:1710148630
Name:CREATIVE COGNITIVE THERAPY PRODUCTIONS
Entity Type:Organization
Organization Name:CREATIVE COGNITIVE THERAPY PRODUCTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:MORSE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-247-4785
Mailing Address - Street 1:2118 CENTRAL AVE SE
Mailing Address - Street 2:SUITE 46
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4004
Mailing Address - Country:US
Mailing Address - Phone:505-247-4785
Mailing Address - Fax:505-247-0710
Practice Address - Street 1:1000 GOLD AVE SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2933
Practice Address - Country:US
Practice Address - Phone:505-247-4785
Practice Address - Fax:505-247-0710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM589103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000N8217Medicaid
1699840389OtherNPI, INDIVIDUAL
1699840389OtherNPI, INDIVIDUAL