Provider Demographics
NPI:1487847091
Name:ARTEMIS ENRICHMENT & LEARNING CENTER, LLC
Entity Type:Organization
Organization Name:ARTEMIS ENRICHMENT & LEARNING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAUGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, MHSP
Authorized Official - Phone:423-292-4673
Mailing Address - Street 1:PO BOX 4475
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-4475
Mailing Address - Country:US
Mailing Address - Phone:423-292-4673
Mailing Address - Fax:
Practice Address - Street 1:112 EAST MYRTLE AVENUE
Practice Address - Street 2:SUITE 408
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601
Practice Address - Country:US
Practice Address - Phone:423-292-4673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1498101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty