Healthcare Provider Details

I. General information

NPI: 1891355012
Provider Name (Legal Business Name): WELLNESS CREATIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 DARBY CREEK RD STE 7
LEXINGTON KY
40509-1605
US

IV. Provider business mailing address

2217 SHANNAWOOD DR
LEXINGTON KY
40513-1333
US

V. Phone/Fax

Practice location:
  • Phone: 859-287-4111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name: AMBER COLLIVER
Title or Position: OWNER
Credential: MT-BC
Phone: 859-806-8804