Healthcare Provider Details

I. General information

NPI: 1699594549
Provider Name (Legal Business Name): WOVEN PATH ART THERAPY AND COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 10/08/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 CLEVELAND AVE STE 209
ISHPEMING MI
49849-1849
US

IV. Provider business mailing address

624 IRON ST
ISHPEMING MI
49849-1152
US

V. Phone/Fax

Practice location:
  • Phone: 906-262-0247
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: AMY RYNN
Title or Position: THERAPIST
Credential:
Phone: 906-262-0247