=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922431279
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFE'S JOURNEY CREATIVE ARTSTHERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2013
-----------------------------------------------------
Last Update Date | 08/09/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 80 CHURCH ST 2ND FLOOR
-----------------------------------------------------
City | HOOSICK FALLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12090-1902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-256-2368
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 212
-----------------------------------------------------
City | HOOSICK FALLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12090-0212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-256-2368
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. EILEEN DRUCKENMILLER
-----------------------------------------------------
Credential | ATR-BC, LCAT
-----------------------------------------------------
Telephone | 518-256-2368
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 001656-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------