Healthcare Provider Details

I. General information

NPI: 1285257386
Provider Name (Legal Business Name): CREATIVE HEALING THERAPY SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2020
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 QUAIL ST STE 275
NEWPORT BEACH CA
92660-2762
US

IV. Provider business mailing address

1400 QUAIL ST STE 275
NEWPORT BEACH CA
92660-2762
US

V. Phone/Fax

Practice location:
  • Phone: 657-215-0465
  • Fax: 949-209-1980
Mailing address:
  • Phone: 657-215-0465
  • Fax: 949-209-1980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. RACHEL M IRISH
Title or Position: OWNER/CEO
Credential: PHD
Phone: 951-529-2772