Provider Demographics
NPI:1750754107
Name:CREATIVE BEHAVIORAL CONNECTIONS LLC
Entity type:Organization
Organization Name:CREATIVE BEHAVIORAL CONNECTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ABBY
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-338-8373
Mailing Address - Street 1:3634 N RANCHO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3149
Mailing Address - Country:US
Mailing Address - Phone:702-338-8373
Mailing Address - Fax:702-645-2606
Practice Address - Street 1:5831 W CRAIG RD # 106
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2579
Practice Address - Country:US
Practice Address - Phone:702-901-5200
Practice Address - Fax:702-901-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20141631437251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health