Provider Demographics
NPI:1598329864
Name:ART OF THE SOUL, CENTER FOR EXPRESSIVE ARTS LLC
Entity Type:Organization
Organization Name:ART OF THE SOUL, CENTER FOR EXPRESSIVE ARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:317-250-9534
Mailing Address - Street 1:3910 N CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-3911
Mailing Address - Country:US
Mailing Address - Phone:317-250-9534
Mailing Address - Fax:
Practice Address - Street 1:2555 55TH PL STE 201
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-3550
Practice Address - Country:US
Practice Address - Phone:317-250-9534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty