Healthcare Provider Details

I. General information

NPI: 1487522082
Provider Name (Legal Business Name): CREATIVE MINDS BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2025
Last Update Date: 10/25/2025
Certification Date: 10/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12312 TIQUISATE AVE
EDINBURG TX
78541-7066
US

IV. Provider business mailing address

12312 TIQUISATE AVE
EDINBURG TX
78541-7066
US

V. Phone/Fax

Practice location:
  • Phone: 956-207-9554
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: PRISCILLA ROSE CANTU
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 956-207-9554