Provider Demographics
NPI:1477171429
Name:RUMSEY, KARISSA FAILS (LPC, ATR-BC)
Entity Type:Individual
Prefix:MRS
First Name:KARISSA
Middle Name:FAILS
Last Name:RUMSEY
Suffix:
Gender:F
Credentials:LPC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 LEXI LN
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46040-9117
Mailing Address - Country:US
Mailing Address - Phone:509-464-9608
Mailing Address - Fax:
Practice Address - Street 1:11109 LEXI LN
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46040-9117
Practice Address - Country:US
Practice Address - Phone:509-464-9608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
221700000X
VA0701002157101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
88-011OtherART THERAPY CREDENTIALS BOARD, INC.