=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831327105
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CREATIVE COMMUNICATION COUNSELING INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2009
-----------------------------------------------------
Last Update Date | 12/11/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3629 W MACARTHUR BLVD STE 209
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92704-6844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-241-8815
-----------------------------------------------------
Fax | 714-551-8817
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3629 W MACARTHUR BLVD STE 209
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92704-6844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-241-8815
-----------------------------------------------------
Fax | 714-551-8817
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DIRECTOR
-----------------------------------------------------
Name | MS. ROBIN L VAN BUREN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-241-8815
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number | SP11954
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------