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General NPI Number Information
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NPI Number | 1184515306
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Entity Type | Organization
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Legal Business Name | CREATIVE SPARK ART THERAPY LLC
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Dates
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Enumeration Date | 07/14/2025
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 122 4TH AVE STE 200
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City | INDIALANTIC
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State | FL
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Zip | 32903-3112
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Country | US
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Telephone | 321-327-3793
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Fax |
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Provider Business Mailing Address
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Address Line | 344 MEADOWWOOD LN
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-3824
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Country | US
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Telephone | 321-536-3195
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL THERAPIST
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Name | JESSICA TERMINI
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Credential | LMHC, ATR
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Telephone | 321-327-3793
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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