NPIMap

Organization Active NPI

Creative ABA, LLC

  • Behavior Analyst
  • Modesto, CA
National Provider Identifier
1619623154
Registry record updated Feb 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
CREATIVE ABA, LLC
Practice address
3720 Glenview Cir
Modesto, CA 95355-1309
Phone
(209) 408-9922
NPI assigned
Feb 23, 2022
Last updated
Feb 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Alexis Rose Winters, BCBANPI 1144793225
Title
Clinical Director
Phone
(209) 408-9992

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193400000X SINGLE SPECIALTY GROUP 103K00000X Primary
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

3720 Glenview Cir
Modesto, CA 95355-1309

Mailing address

3720 Glenview Cir
Modesto, CA 95355-1309
Phone (209) 408-9922

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1645574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645747200000",
    "number": "1619623154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3720 GLENVIEW CIR",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551309",
            "telephone_number": "209-408-9922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3720 GLENVIEW CIR",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551309",
            "telephone_number": "209-408-9922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREATIVE ABA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-23",
        "last_updated": "2022-02-25",
        "certification_date": "2022-02-25",
        "status": "A",
        "authorized_official_last_name": "WINTERS",
        "authorized_official_first_name": "ALEXIS",
        "authorized_official_middle_name": "ROSE",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "209-408-9992",
        "authorized_official_credential": "BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.