Provider Demographics
NPI:1013613058
Name:YOUTHFUL CREATIONS AND INTERVENTIONS
Entity type:Organization
Organization Name:YOUTHFUL CREATIONS AND INTERVENTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROSEBOROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-543-9974
Mailing Address - Street 1:3667 N PLUM TREE AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92377-2701
Mailing Address - Country:US
Mailing Address - Phone:909-543-9974
Mailing Address - Fax:
Practice Address - Street 1:3667 N PLUM TREE AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92377-2701
Practice Address - Country:US
Practice Address - Phone:909-543-9974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-01
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty