Provider Demographics
NPI:1861090441
Name:ILLUMINATING PSYCHOLOGICAL SERVICES CORPORATION
Entity type:Organization
Organization Name:ILLUMINATING PSYCHOLOGICAL SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:INA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CREEKBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:909-856-5904
Mailing Address - Street 1:967 KENDALL DR STE A515
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-4306
Mailing Address - Country:US
Mailing Address - Phone:951-981-2383
Mailing Address - Fax:855-595-2795
Practice Address - Street 1:1650 SPRUCE ST STE 240
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-7403
Practice Address - Country:US
Practice Address - Phone:951-981-2383
Practice Address - Fax:855-595-2795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty