Provider Demographics
NPI:1003276791
Name:FLATHEAD VALLEY ART THERAPY, LLC
Entity Type:Organization
Organization Name:FLATHEAD VALLEY ART THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LCPC
Authorized Official - Prefix:
Authorized Official - First Name:ALLYSON
Authorized Official - Middle Name:NORWOOD
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:X
Authorized Official - Credentials:MA, ATR, LCPC
Authorized Official - Phone:406-212-7576
Mailing Address - Street 1:306 5TH AVE E
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4925
Mailing Address - Country:US
Mailing Address - Phone:406-212-7576
Mailing Address - Fax:
Practice Address - Street 1:723 5TH AVE E
Practice Address - Street 2:126
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-5321
Practice Address - Country:US
Practice Address - Phone:406-212-7576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1482101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty