Provider Demographics
NPI:1023738739
Name:CR8TIVE MINDZ
Entity type:Organization
Organization Name:CR8TIVE MINDZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CO-FOUNDER, LCSW
Authorized Official - Prefix:
Authorized Official - First Name:KANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-654-7485
Mailing Address - Street 1:556 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-2506
Mailing Address - Country:US
Mailing Address - Phone:323-402-1803
Mailing Address - Fax:
Practice Address - Street 1:1777 N BELLFLOWER BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-4019
Practice Address - Country:US
Practice Address - Phone:323-402-1803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health