MEDICARE: CREATIVE HEALING THERAPY SOLUTIONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	103TC0700X	Clinical Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285257386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATIVE HEALING THERAPY SOLUTIONS

Provider Business Mailing Address
First Line	:	1400 QUAIL ST STE 275
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2762
Country	:	US
Telephone Number	:	657-215-0465
Fax Number	:	949-209-1980

Provider Business Practice Location Address
First Line	:	1400 QUAIL ST STE 275
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2762
Country	:	US
Telephone Number	:	657-215-0465
Fax Number	:	949-209-1980

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	DR. RACHEL M IRISH
Credential	:	PHD
Telephone Number	:	951-529-2772

Provider Enumeration Date	:	05/22/2020
Last Update Date	:	06/21/2022

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