MEDICARE: KREATIVE SOLUTIONS LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1679263826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KREATIVE SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	13337 SOUTH ST # 287
Second Line	:
City	:	CERRITOS
State	:	CA
Zip	:	90703-7308
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4480 W PEORIA AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-2038
Country	:	US
Telephone Number	:	602-753-9202
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RYAN BOOKER
Credential	:
Telephone Number	:	602-753-9202

Provider Enumeration Date	:	05/11/2023
Last Update Date	:	05/11/2023

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Directions to “KREATIVE SOLUTIONS LLC ” Practice Location

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