MEDICARE: CREATIVE KIDS BEHAVIORAL CONSULTING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1245580216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATIVE KIDS BEHAVIORAL CONSULTING

Provider Business Mailing Address
First Line	:	6660 DELMONICO DR STE D214
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-1899
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	408 W ROCKRIMMON BLVD UNIT A
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-1738
Country	:	US
Telephone Number	:	414-559-6678
Fax Number	:	719-213-2098

Authorized Official
Title or Position	:	BEHAVIOR ANALYST/MANAGER
Name	:	CORRINE KIRSCH
Credential	:
Telephone Number	:	414-559-6678

Provider Enumeration Date	:	09/17/2012
Last Update Date	:	10/04/2021

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Directions to “CREATIVE KIDS BEHAVIORAL CONSULTING ” Practice Location

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