Illuminating Psychological Services Corporation

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

Legal business name

ILLUMINATING PSYCHOLOGICAL SERVICES CORPORATION

Practice address

1650 Spruce St Ste 240
Riverside, CA 92507-7403

Phone

(951) 981-2383

Fax

(855) 595-2795

NPI assigned

Oct 15, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Ina J Creekbaum, ED.DNPI 1528522216

Title

Owner

Phone

(909) 856-5904

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• California Healing Horizons

  • Clinic/Center
  • Riverside, CA
  • NPI 1932930120
  NPPES parent name

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ina Creekbaum, EDD

  • Counseling Psychologist
  • Riverside, CA
  • NPI 1528522216
  Medicare reassignment Authorized official
• Roberto J. Vado, ED.D.

  • Psychologist
  • Burbank, CA
  • NPI 1740601228
  Medicare reassignment NPD
• Raz Derakhshan

  • Marriage & Family Therapist
  • Riverside, CA
  • NPI 1316772353
  NPD
• Jessica Jamile Faragallah, PHD

  • Clinical Psychologist
  • Westlake Village, CA
  • NPI 1346019478
  NPD

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

{
    "created_epoch": "1602720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741910400000",
    "number": "1861090441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "967 KENDALL DR STE A515",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924074306",
            "telephone_number": "951-981-2383",
            "fax_number": "855-595-2795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 SPRUCE ST STE 240",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925077403",
            "telephone_number": "951-981-2383",
            "fax_number": "855-595-2795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLUMINATING PSYCHOLOGICAL SERVICES CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-15",
        "last_updated": "2025-03-14",
        "certification_date": "2025-03-14",
        "status": "A",
        "authorized_official_last_name": "CREEKBAUM",
        "authorized_official_first_name": "INA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-856-5904",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ED.D"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joanna Jacqueline Ikenasio
• Yeneochia Ikhelowa, MPH, MBA, CPCO
• Augusta Uayemen Ikhisemojie, M.D.
• Clark Ilagan
• Pavel Constantin Ilie, PPS
• Illumination Health and Home
• Kristian Jared Ilustre, DPT
• Alisha Ilyin, NP
• Jonathan Im
• Dana Catherine Imai

• Counseling Psychologist in Riverside, CA
• Providers in Riverside, CA by specialty
• Counseling Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.