Basic Information
| Provider Information | |||||||||
| NPI: | 1285257386 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CREATIVE HEALING THERAPY SOLUTIONS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 QUAIL ST STE 275 | ||||||||
| Address2: | |||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926602762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6572150465 | ||||||||
| FaxNumber: | 9492091980 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 QUAIL ST STE 275 | ||||||||
| Address2: | |||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926602762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6572150465 | ||||||||
| FaxNumber: | 9492091980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2020 | ||||||||
| LastUpdateDate: | 06/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | IRISH | ||||||||
| AuthorizedOfficialFirstName: | RACHEL | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/CEO | ||||||||
| AuthorizedOfficialTelephone: | 9515292772 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
| NPICertificationDate: | 06/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | N | Agencies | Community/Behavioral Health | 103TC0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 100211512 | 05 | CA | MEDICAID |