Healthcare Provider Details

I. General information

NPI: 1487519070
Provider Name (Legal Business Name): CENTER FOR CREATIVE STUDIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8205 SPAIN RD NE STE 201
ALBUQUERQUE NM
87109-3130
US

IV. Provider business mailing address

14109 GRAND AVE NE
ALBUQUERQUE NM
87123-1802
US

V. Phone/Fax

Practice location:
  • Phone: 505-440-3226
  • Fax: 505-275-5756
Mailing address:
  • Phone: 505-440-3226
  • Fax: 505-275-7576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: CHRISTY TACKWELL
Title or Position: CEO
Credential: LPCC LPAT ATR
Phone: 505-440-3226