Basic Information
| Provider Information | |||||||||
| NPI: | 1841403623 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CREATIVE SOLUTIONS TO BEHAVIORAL MANAGEMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3817 E STATE ROAD 64 | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342089041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417455111 | ||||||||
| FaxNumber: | 9417455667 | ||||||||
| Practice Location | |||||||||
| Address1: | 3817 E STATE ROAD 64 | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342089041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417455111 | ||||||||
| FaxNumber: | 9417455667 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WHITE | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9417455111 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MRC, CRC, LMHC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.