Provider Demographics
NPI:1720731219
Name:MARIPOSITA: CREATIVE AND THERAPEUTIC SOLUTIONS
Entity Type:Organization
Organization Name:MARIPOSITA: CREATIVE AND THERAPEUTIC SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMBER KHYRA
Authorized Official - Middle Name:JAMISEN
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:850-766-2628
Mailing Address - Street 1:26 TALON DR
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-2359
Mailing Address - Country:US
Mailing Address - Phone:859-766-2628
Mailing Address - Fax:
Practice Address - Street 1:26 TALON DR
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-2359
Practice Address - Country:US
Practice Address - Phone:859-766-2628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health