Healthcare Provider Details

I. General information

NPI: 1598690612
Provider Name (Legal Business Name): EXPRESSIVE REGULATION CREATIVE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 E ELLIOT RD # 1124
GILBERT AZ
85234-6729
US

IV. Provider business mailing address

PO BOX 1124
GILBERT AZ
85299-1124
US

V. Phone/Fax

Practice location:
  • Phone: 480-788-1418
  • Fax:
Mailing address:
  • Phone: 480-788-1418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. YVETTE M JACKSON
Title or Position: MANAGING MEMBER/CO-FOUNDER
Credential:
Phone: 480-788-1418