=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457876203
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEUROSOUND MUSIC THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2017
-----------------------------------------------------
Last Update Date | 01/09/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10340 DEMOCRACY LN STE 302
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22030-2518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-367-9951
-----------------------------------------------------
Fax | 703-757-8315
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 91
-----------------------------------------------------
City | HAYMARKET
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20168-0091
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-367-9951
-----------------------------------------------------
Fax | 703-754-8315
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MUSIC THERAPIST
-----------------------------------------------------
Name | KELSI SHEA TAFARO
-----------------------------------------------------
Credential | MT-BC
-----------------------------------------------------
Telephone | 571-367-9951
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225A00000X
-----------------------------------------------------
Taxonomy Name | Music Therapist
-----------------------------------------------------
License Number | 11015
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------