Healthcare Provider Details

I. General information

NPI: 1396385886
Provider Name (Legal Business Name): URBAN ACT ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MARKET ST
INDIANAPOLIS IN
46202-3831
US

IV. Provider business mailing address

1250 E MARKET ST
INDIANAPOLIS IN
46202-3831
US

V. Phone/Fax

Practice location:
  • Phone: 317-226-4214
  • Fax:
Mailing address:
  • Phone: 317-226-4214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: NIGENA LIVINGSTON
Title or Position: HEAD OF SCHOOL
Credential:
Phone: 317-226-4214