Provider Demographics
NPI:1750650933
Name:CREATIVE BEHAVIOR INTERVENTIONS
Entity Type:Organization
Organization Name:CREATIVE BEHAVIOR INTERVENTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, BCBA-D
Authorized Official - Phone:949-861-1580
Mailing Address - Street 1:3002 DOW AVE
Mailing Address - Street 2:SUITE 520
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7233
Mailing Address - Country:US
Mailing Address - Phone:949-861-1580
Mailing Address - Fax:949-328-7689
Practice Address - Street 1:3002 DOW AVE
Practice Address - Street 2:SUITE 520
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7233
Practice Address - Country:US
Practice Address - Phone:949-861-1580
Practice Address - Fax:949-328-7689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-07-3777103K00000X, 251C00000X
CAPSY22024103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty