Provider Demographics
NPI:1871016279
Name:VETERAN ART THERAPY
Entity Type:Organization
Organization Name:VETERAN ART THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, ART THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MIMS
Authorized Official - Suffix:
Authorized Official - Credentials:ATR, LPC-I
Authorized Official - Phone:580-647-6427
Mailing Address - Street 1:305 STEAD DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76705-1536
Mailing Address - Country:US
Mailing Address - Phone:580-647-6427
Mailing Address - Fax:
Practice Address - Street 1:305 STEAD DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76705-1536
Practice Address - Country:US
Practice Address - Phone:580-647-6427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74997261QM0801X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)