Healthcare Provider Details

I. General information

NPI: 1154788032
Provider Name (Legal Business Name): MAINSTAY MUSIC THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2016
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10812 COLDWATER RD STE 400
FORT WAYNE IN
46845-1204
US

IV. Provider business mailing address

1910 SAINT JOE CENTER RD STE 44
FORT WAYNE IN
46825-5000
US

V. Phone/Fax

Practice location:
  • Phone: 260-409-8246
  • Fax:
Mailing address:
  • Phone: 260-494-1624
  • Fax: 260-494-1624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name: ALLISON THOMAS
Title or Position: CEO/OWNER
Credential: MT-BC
Phone: 260-494-1624