Healthcare Provider Details

I. General information

NPI: 1295374205
Provider Name (Legal Business Name): HELEN R KLING MA, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DREAMA PHOENIX

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S, LOCUST
JASPER AR
72641-0741
US

IV. Provider business mailing address

P.O. BOX 766 (102 S, LOCUST)
JASPER AR
72641-0741
US

V. Phone/Fax

Practice location:
  • Phone: 479-790-0400
  • Fax:
Mailing address:
  • Phone: 479-790-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number89-065
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: