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General NPI Number Information
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NPI Number | 1750650933
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Entity Type | Organization
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Legal Business Name | CREATIVE BEHAVIOR INTERVENTIONS
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Dates
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Enumeration Date | 12/19/2011
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Last Update Date | 12/19/2011
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Provider Practice Location Address
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Address Line | 3002 DOW AVE SUITE 520
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City | TUSTIN
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State | CA
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Zip | 92780-7233
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Country | US
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Telephone | 949-861-1580
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Fax | 949-328-7689
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Provider Business Mailing Address
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Address Line | 3002 DOW AVE SUITE 520
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City | TUSTIN
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State | CA
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Zip | 92780-7233
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Country | US
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Telephone | 949-861-1580
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Fax | 949-328-7689
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DENISE MARIE ECKMAN
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Credential | PSY.D., BCBA-D
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Telephone | 949-861-1580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | PSY22024
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 1-07-3777
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-07-3777
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License Number State | CA
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