Provider Demographics
NPI:1659126092
Name:THERAPEUTIC ARTS COLLECTIVE, INC
Entity Type:Organization
Organization Name:THERAPEUTIC ARTS COLLECTIVE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:727-687-7969
Mailing Address - Street 1:2722 3RD AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-7822
Mailing Address - Country:US
Mailing Address - Phone:727-687-7969
Mailing Address - Fax:
Practice Address - Street 1:5401 22ND AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-5124
Practice Address - Country:US
Practice Address - Phone:727-687-7969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty