NPIMap

Organization Active NPI

Creative Life Behavioral Health Service

  • Counselor
  • Las Vegas, NV
National Provider Identifier
1932446069
Registry record updated Jan 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
570574888 Issued in CA
Legal business name
CREATIVE LIFE BEHAVIORAL HEALTH SERVICE
Practice address
5175 Camino Al Norte
Las Vegas, NV 89031
Phone
(702) 648-3913
NPI assigned
Jan 9, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2013

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

Authorized official

Name
Ieasha Nicole Pettus
Title
BST
Phone
(702) 643-0713

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X 570574888 CA Primary

Addresses

Primary practice location

5175 Camino Al Norte
Las Vegas, NV 89031

Mailing address

5175 Camino Al Norte
North Las Vegas, NV 89031-2407
Phone (702) 648-3913

National Provider Directory

National Provider Directory
Tax ID family
Ar Diversified Human Services24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

Organizations that report the same tax identification number in the National Provider Directory.

View all 23

Locations

5175 Camino Al Norte
North Las Vegas, NV 89031
Phone (702) 648-3913

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1357689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357689600000",
    "number": "1932446069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5175 CAMINO AL NORTE",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890312407",
            "telephone_number": "702-648-3913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5175 CAMINO AL NORTE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89031",
            "telephone_number": "702-648-3913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREATIVE LIFE BEHAVIORAL HEALTH SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-09",
        "last_updated": "2013-01-09",
        "status": "A",
        "authorized_official_last_name": "PETTUS",
        "authorized_official_first_name": "IEASHA",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "BST",
        "authorized_official_telephone_number": "702-643-0713"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "CA",
            "license": "570574888",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2013; 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.