Provider Demographics
NPI:1710411889
Name:ART THERAPY OF MN
Entity Type:Organization
Organization Name:ART THERAPY OF MN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:952-270-9108
Mailing Address - Street 1:4448 CEDAR AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3628
Mailing Address - Country:US
Mailing Address - Phone:952-270-9108
Mailing Address - Fax:
Practice Address - Street 1:2637 27TH AVE S STE 229
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-3089
Practice Address - Country:US
Practice Address - Phone:952-270-9108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-16
Last Update Date:2017-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01403251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health