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General NPI Number Information
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NPI Number | 1245050020
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Entity Type | Organization
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Legal Business Name | NEW BRANCH ART THERAPY SERVICES LLC
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 14411 KINGSTON ST
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City | OAK PARK
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State | MI
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Zip | 48237-1141
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Country | US
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Telephone | 248-217-4419
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Fax |
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Provider Business Mailing Address
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Address Line | 14411 KINGSTON ST
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City | OAK PARK
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State | MI
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Zip | 48237-1141
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR/OPS MANAGER
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Name | KATHRYN ELIZABETH WHITLOCK
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Credential | ATR-BC, LPC, CCTP-II
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Telephone | 248-217-4419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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