ILLUMINATING PSYCHOLOGICAL SERVICES CORPORATION (NPI# 1861090441) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861090441 |
| Entity Type | Organization |
| Organization Name | ILLUMINATING PSYCHOLOGICAL SERVICES CORPORATION |
| Practice Address |
4181 Flat Rock Dr Ste 311 Riverside CA 92505-7106 |
| Mailing Address |
967 Kendall Dr Ste A515 San Bernardino CA 92407-4306 |
| Practice Telephone | 9098565904 |
| Practice Fax Number | 9514680609 |
| Mailing Telephone | 9098565904 |
| Mailing Fax Number | 9514680609 |
| Enumeration Date | 2020-10-15 |
| Last Update Date | 2020-10-15 |
| Authorized Official Name | DR. INA J CREEKBAUM (OWNER) |
| Authorized Official Telephone | 9098565904 |
| Authorized Official Credential | ED.D |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC1900X |
Psychologist Specialization: Counseling |
Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 967 Kendall Dr Ste A-515, San Bernardino, CA 924074306 | 9098565904 | 9514680609 |
| Street Address |
4181 FLAT ROCK DR STE 311 |
| City | RIVERSIDE |
| State | CA |
| Zip Code | 92505-7106 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205458460 | Mark Anthony Vargas | Behavioral Analyst | 94193 Flat Rock Dr Ste 220, Riverside, CA 92505 | 2020-05-11 |
| 1568099976 | Victoria Lee | Student in an Organized Health Care Education/Training Program | Riverside Family Medicine Residency, 10800 Magnolia Avenue, Riverside, CA 92505 | 2020-03-25 |
| 1588222087 | A Homecare Services, Inc | In Home Supportive Care | 4193 Flat Rock Road, Building 200 Suite 206, Riverside, CA 92505 | 2019-05-31 |
| 1609302397 | Tap Pharmacy, Inc. | Pharmacy | 4270 Riverwalk Pkwy Ste 102, Riverside, CA 92505 | 2017-05-02 |
| 1467998658 | Onofre Gascon | Behavior Technician | 11711 Collett Ave, #1614, Riverside, CA 92505 | 2017-01-11 |
| 1780038505 | Nash David Martinez | Emergency Medicine | 10800 Magnolia Ave Dept of Emergency Medicine, Kaiser Permanente Hospital, Riverside, CA 92505 | 2016-04-18 |
| 1447639901 | Jose Joel Manalese Dds Inc | Dentist | 3950 Pierce St., Suite L., Riverside, CA 92505 | 2015-05-29 |
| 1821493230 | Jean Huynh | Physician Assistant | 11725 State Ave., Suite 100, Riverside, CA 92505 | 2014-10-28 |
| 1003160649 | Elaf Farahat | Dietitian, Registered | 10800 Magnolia Avenue., Riverside, CA 92505 | 2012-11-05 |
| 1730458217 | Tammy Lynn Gilmore | Non-emergency Medical Transport (VAN) | 10770 Hole Avenue, 106, Riverside, CA 92505 | 2011-12-29 |
| Find all providers in zip 92505 | ||||
| Taxonomy Code | 103TC1900X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Counseling |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528522216 | Ina Creekbaum | Psychologist | 4181 Flat Rock Dr Ste 300, Riverside, CA 92505-7106 | 2019-01-26 |
| 1245508688 | Alesia Nesie Fuller | Psychologist | 4129 Main St., Suite 202, Riverside, CA 92501 | 2011-12-13 |
| 1487805545 | Lee Stillerman | Psychologist | Ucr Counseling Ctr, Veitch Student Center, North Wing, Riverside, CA 92521-0001 | 2008-10-08 |
| 1467619544 | Shauna E. Summers | Psychologist | 250 Wampanoag Trl Ste 303, Riverside, RI 02915-2217 | 2008-05-17 |
| 1134259385 | Brad Kenneth Compliment | Psychologist | The Counseling Center At Ucr, Veitch Center, North Wing, Riverside, CA 92521-0001 | 2007-03-06 |
| 1366828386 | Ralford Jones | Psychologist | 3634 Elizabeth St, Riverside, CA 92506-2506 | 2015-07-31 |
| 1194116988 | Manijeh Badiee | Psychologist | 5051 Canyon Crest Dr, Suite 204, Riverside, CA 92507-6099 | 2015-02-15 |
| 1124360342 | University of California Riverside | Psychologist | 900 University Ave, Veitch Student Center, North Wing, Riverside, CA 92521 | 2013-03-26 |
| 1215107354 | Orthopaedic Medical Group of Riverside, Inc. | Psychologist | 6850 Brockton Ave, Suite 212, Riverside, CA 92506-3808 | 2008-03-05 |
| 1396766853 | Lynda Walker Warren | Psychologist | 4515 Central Ave, Suite 203, Riverside, CA 92506-2374 | 2006-07-21 |
| Find all providers in RIVERSIDE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.