=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992470280
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALABASTER CREATIVE ARTS THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2021
-----------------------------------------------------
Last Update Date | 08/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 132 S MARKET ST STE 204
-----------------------------------------------------
City | WOOSTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44691-4765
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-641-4413
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 132 S MARKET ST STE 204
-----------------------------------------------------
City | WOOSTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44691-4765
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-641-4413
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | MS. LEAH M MENDEZ CARMONA
-----------------------------------------------------
Credential | LPCC-S
-----------------------------------------------------
Telephone | 330-641-4413
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------