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General NPI Number Information
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NPI Number | 1710396122
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Entity Type | Organization
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Legal Business Name | THE ART THERAPY STUDIO
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Dates
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Enumeration Date | 08/11/2014
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Last Update Date | 08/11/2014
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Provider Practice Location Address
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Address Line | 108 S ALBANY ST SUITE 2
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City | ITHACA
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State | NY
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Zip | 14850-5446
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Country | US
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Telephone | 716-225-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 108 S ALBANY ST SUITE 2
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City | ITHACA
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State | NY
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Zip | 14850-5446
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Country | US
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Telephone | 716-225-0700
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Fax |
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Authorized Official
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Title or Position | LICENSED CREATIVE ARTS THERAPIST
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Name | MS. EMILY J MILLEN
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Credential | L.C.A.T., A.T.R.B.C
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Telephone | 716-225-0700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 001526-1
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License Number State | NY
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