Provider Demographics
NPI:1528522216
Name:CREEKBAUM, INA (EDD)
Entity type:Individual
Prefix:DR
First Name:INA
Middle Name:
Last Name:CREEKBAUM
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:909-856-5904
Mailing Address - Fax:
Practice Address - Street 1:4181 FLAT ROCK DR STE 300
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-7106
Practice Address - Country:US
Practice Address - Phone:909-856-5904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-26
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30705103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling