Provider Demographics
NPI:1245010149
Name:AURA ART SPACE PLLC
Entity type:Organization
Organization Name:AURA ART SPACE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & SENIOR CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ESSENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, ATR
Authorized Official - Phone:773-403-7605
Mailing Address - Street 1:7545 E NORTHWEST HWY APT 320
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-4234
Mailing Address - Country:US
Mailing Address - Phone:773-403-7605
Mailing Address - Fax:
Practice Address - Street 1:7545 E NORTHWEST HWY APT 320
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-4234
Practice Address - Country:US
Practice Address - Phone:773-256-7253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251B00000XAgenciesCase Management
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health