Provider Demographics
NPI:1508239732
Name:THE ART EXPERIENCE, INC.
Entity Type:Organization
Organization Name:THE ART EXPERIENCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KAMINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:479-442-0557
Mailing Address - Street 1:641 W MARTIN LUTHER KING BLVD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-6444
Mailing Address - Country:US
Mailing Address - Phone:479-442-0557
Mailing Address - Fax:479-587-1387
Practice Address - Street 1:641 W MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-6444
Practice Address - Country:US
Practice Address - Phone:479-442-0557
Practice Address - Fax:479-587-1387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health