Healthcare Provider Details

I. General information

NPI: 1215878236
Provider Name (Legal Business Name): THE CREATIVE SANCTUARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11528 W STATE ROAD 84 # 551447
DAVIE FL
33325-4022
US

IV. Provider business mailing address

11528 W STATE ROAD 84 # 551447
DAVIE FL
33325-4022
US

V. Phone/Fax

Practice location:
  • Phone: 954-998-2538
  • Fax:
Mailing address:
  • Phone: 954-998-2538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KAILEY KRUPAR
Title or Position: FOUNDER & THERAPIST
Credential: MS, ATR-BC, LMHC
Phone: 954-998-2538