Organization
CREATIVE LIFE BEHAVIORAL HEALTH SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IEASHA NICOLE PETTUS (BST)
(702) 643-0713
Entity
Organization
Contact information
Practice address
5175 CAMINO AL NORTE, LAS VEGAS, NV 89031
(702) 648-3913
Mailing address
5175 CAMINO AL NORTE, NORTH LAS VEGAS, NV 89031-2407
(702) 648-3913
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
570574888
CA
Other
Enumeration date
01/09/2013
Last updated
01/09/2013
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