Healthcare Provider Details

I. General information

NPI: 1629801337
Provider Name (Legal Business Name): CREATIVE BEHAVIORAL CONNECTIONS UTAH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 S BLUFF ST STE 3
ST GEORGE UT
84770-3593
US

IV. Provider business mailing address

2921 N TENAYA WAY
LAS VEGAS NV
89128-0454
US

V. Phone/Fax

Practice location:
  • Phone: 702-901-5200
  • Fax: 702-901-5201
Mailing address:
  • Phone: 702-978-8000
  • Fax: 702-978-8004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ABBY GROSSA
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 702-338-8373