Provider Demographics
NPI:1013153113
Name:CENTER FOR CREATIVE THERAPEUTIC ARTS
Entity Type:Organization
Organization Name:CENTER FOR CREATIVE THERAPEUTIC ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:PINKERTON
Authorized Official - Suffix:
Authorized Official - Credentials:MT-BC
Authorized Official - Phone:702-363-8166
Mailing Address - Street 1:6375 W CHARLESTON BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1169
Mailing Address - Country:US
Mailing Address - Phone:702-363-8166
Mailing Address - Fax:702-315-4362
Practice Address - Street 1:6375 W CHARLESTON BLVD BLDG L
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1139
Practice Address - Country:US
Practice Address - Phone:702-363-8166
Practice Address - Fax:702-315-4362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-20
Last Update Date:2008-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV225A00000XOtherRESPIRATORY, DEVELOPMENTAL, REHABILITATIVE AND RESTORATIVE SERVICE PROVIDERS