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General NPI Number Information
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NPI Number | 1639666837
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Entity Type | Organization
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Legal Business Name | CREATIVE WELLNESS INSTITUTE
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Dates
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Enumeration Date | 04/13/2018
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Last Update Date | 04/13/2018
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Provider Practice Location Address
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Address Line | 1713 E WALNUT ST
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City | PASADENA
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State | CA
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Zip | 91106-1611
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Country | US
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Telephone | 602-299-4679
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Fax |
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Provider Business Mailing Address
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Address Line | 4001 DON TOMASO DR APT 1
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City | LOS ANGELES
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State | CA
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Zip | 90008-5319
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Country | US
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Telephone | 602-299-4679
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CECCILY BEDNASH
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Credential |
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Telephone | 602-299-4679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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