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General NPI Number Information
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NPI Number | 1861090441
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Entity Type | Organization
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Legal Business Name | ILLUMINATING PSYCHOLOGICAL SERVICES CORPORATION
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Dates
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Enumeration Date | 10/15/2020
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 1650 SPRUCE ST STE 240
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City | RIVERSIDE
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State | CA
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Zip | 92507-7403
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Country | US
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Telephone | 951-981-2383
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Fax | 855-595-2795
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Provider Business Mailing Address
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Address Line | 967 KENDALL DR STE A515
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-4306
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Country | US
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Telephone | 951-981-2383
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Fax | 855-595-2795
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Authorized Official
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Title or Position | OWNER
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Name | DR. INA J CREEKBAUM
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Credential | ED.D
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Telephone | 909-856-5904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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