Provider Demographics
NPI:1720793953
Name:CREATIVITY THE ART OF EXPRESSION LLC
Entity Type:Organization
Organization Name:CREATIVITY THE ART OF EXPRESSION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HACKETTSIEROTA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:813-819-4346
Mailing Address - Street 1:13002 WHITNELL WAY
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7098
Mailing Address - Country:US
Mailing Address - Phone:813-819-4346
Mailing Address - Fax:
Practice Address - Street 1:13002 WHITNELL WAY
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-7098
Practice Address - Country:US
Practice Address - Phone:813-819-4346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty