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General NPI Number Information
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NPI Number | 1508239732
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Entity Type | Organization
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Legal Business Name | THE ART EXPERIENCE, INC.
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Dates
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Enumeration Date | 11/10/2015
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Last Update Date | 11/10/2015
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Provider Practice Location Address
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Address Line | 641 W MARTIN LUTHER KING BLVD
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-6444
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Country | US
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Telephone | 479-442-0557
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Fax | 479-587-1387
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Provider Business Mailing Address
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Address Line | 641 W MARTIN LUTHER KING BLVD
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-6444
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Country | US
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Telephone | 479-442-0557
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Fax | 479-587-1387
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Authorized Official
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Title or Position | BOARD PRESIDENT, THERAPIST
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Name | JO ANN KAMINSKY
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Credential | MED, LPC
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Telephone | 479-442-0557
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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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