MEDICARE: CREATIVE AUTISM TREATMENTS

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1750245163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATIVE AUTISM TREATMENTS

Provider Business Mailing Address
First Line	:	5176 N ROYCE RD
Second Line	:
City	:	SAINT LOUIS
State	:	MI
Zip	:	48880-9262
Country	:	US
Telephone Number	:	352-650-8563
Fax Number	:

Provider Business Practice Location Address
First Line	:	5176 N ROYCE RD
Second Line	:
City	:	SAINT LOUIS
State	:	MI
Zip	:	48880-9262
Country	:	US
Telephone Number	:	352-650-8563
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JENNIFER LYNN RICHARDSON
Credential	:	MS, BCBA, LBA
Telephone Number	:	352-650-8563

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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Directions to “CREATIVE AUTISM TREATMENTS ” Practice Location

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