Provider Demographics
NPI:1730328790
Name:INTERNATIONAL PROBLEM GAMBLING CENTER
Entity type:Organization
Organization Name:INTERNATIONAL PROBLEM GAMBLING CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:CREELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-363-3633
Mailing Address - Street 1:2330 PASEO DEL PRADO STE C109
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-4336
Mailing Address - Country:US
Mailing Address - Phone:702-363-3633
Mailing Address - Fax:702-363-5244
Practice Address - Street 1:2330 PASEO DEL PRADO STE C109
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4336
Practice Address - Country:US
Practice Address - Phone:702-363-3633
Practice Address - Fax:702-363-5244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health