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General NPI Number Information
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NPI Number | 1669338125
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Entity Type | Organization
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Legal Business Name | CREATING CHANGES BEHAVIOR THERAPY LLC
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Dates
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Enumeration Date | 12/29/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 631 E MOWRY CT
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City | HOMESTEAD
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State | FL
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Zip | 33030-8207
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Country | US
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Telephone | 305-992-2446
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Fax |
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Provider Business Mailing Address
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Address Line | 631 E MOWRY CT
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City | HOMESTEAD
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State | FL
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Zip | 33030-8207
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Country | US
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Telephone | 305-992-2446
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Fax | 786-758-4348
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | CARLOS CARRILLO
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Credential |
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Telephone | 305-992-2446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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