Provider Demographics
NPI:1780421917
Name:CREATIVE BEHAVIORAL CONNECTIONS
Entity type:Organization
Organization Name:CREATIVE BEHAVIORAL CONNECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED BEHAVIOR TECHNICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:602-434-0682
Mailing Address - Street 1:10383 ALCOY LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5803 W CRAIG RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2536
Practice Address - Country:US
Practice Address - Phone:702-901-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty