Healthcare Provider Details

I. General information

NPI: 1861090441
Provider Name (Legal Business Name): ILLUMINATING PSYCHOLOGICAL SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 SPRUCE ST STE 240
RIVERSIDE CA
92507-7403
US

IV. Provider business mailing address

967 KENDALL DR STE A515
SAN BERNARDINO CA
92407-4306
US

V. Phone/Fax

Practice location:
  • Phone: 951-981-2383
  • Fax: 855-595-2795
Mailing address:
  • Phone: 951-981-2383
  • Fax: 855-595-2795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. INA J CREEKBAUM
Title or Position: OWNER
Credential: ED.D
Phone: 909-856-5904