Provider Demographics
NPI:1992724934
Name:CRISARA CREATIVE THERAPY, LLC
Entity type:Organization
Organization Name:CRISARA CREATIVE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR OF COUNSELING
Authorized Official - Prefix:MRS
Authorized Official - First Name:AVA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCPC
Authorized Official - Phone:916-422-8862
Mailing Address - Street 1:PO BOX 581748
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-0030
Mailing Address - Country:US
Mailing Address - Phone:916-422-8862
Mailing Address - Fax:916-422-2050
Practice Address - Street 1:7000 FRANKLIN BOULEVARD
Practice Address - Street 2:SUITE 350
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-1839
Practice Address - Country:US
Practice Address - Phone:916-422-8862
Practice Address - Fax:916-422-2050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YP2500X
CA9555251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV797P-7015AOtherFEDERAL GSA/FSS
CA31474OtherDEPT OF TRANSPORTATION
CAZZZ67877ZOtherBLUE SHIELD/BLUE CROSS
CA6DN00022OtherCPUC