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General NPI Number Information
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NPI Number | 1003276791
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Entity Type | Organization
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Legal Business Name | FLATHEAD VALLEY ART THERAPY, LLC
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Dates
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Enumeration Date | 02/24/2016
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Last Update Date | 02/24/2016
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Provider Practice Location Address
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Address Line | 723 5TH AVE E 126
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City | KALISPELL
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State | MT
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Zip | 59901-5321
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Country | US
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Telephone | 406-212-7576
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Fax |
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Provider Business Mailing Address
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Address Line | 306 5TH AVE E
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City | KALISPELL
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State | MT
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Zip | 59901-4925
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Country | US
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Telephone | 406-212-7576
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Fax |
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Authorized Official
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Title or Position | OWNER/LCPC
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Name | ALLYSON NORWOOD BUSH X
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Credential | MA, ATR, LCPC
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Telephone | 406-212-7576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1482
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License Number State | MT
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