MEDICARE: COMMUNITY ARTS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YP2500X	Professional Counselor
3	221700000X	Art Therapist
4	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1780296111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY ARTS LLC

Provider Business Mailing Address
First Line	:	8700 MENCHACA RD STE 202
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-5373
Country	:	US
Telephone Number	:	512-577-7483
Fax Number	:

Provider Business Practice Location Address
First Line	:	8700 MENCHACA RD STE 202
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-5373
Country	:	US
Telephone Number	:	512-577-7483
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WANDA MONTEMAYOR
Credential	:	LPC-S-AT RPT-S ATCS
Telephone Number	:	512-577-7483

Provider Enumeration Date	:	08/18/2020
Last Update Date	:	08/20/2020

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Directions to “COMMUNITY ARTS LLC ” Practice Location

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