Provider Demographics
NPI:1114612470
Name:PARADISE ART THERAPY CENTER LLC
Entity Type:Organization
Organization Name:PARADISE ART THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:PARADISE
Authorized Official - Last Name:TREMONT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, ATR-BC
Authorized Official - Phone:248-342-6541
Mailing Address - Street 1:7007 16 MILE RD UNIT 314
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48311-7056
Mailing Address - Country:US
Mailing Address - Phone:248-342-6541
Mailing Address - Fax:
Practice Address - Street 1:12227 POLARA DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-4072
Practice Address - Country:US
Practice Address - Phone:248-342-6541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty