Provider Demographics
NPI:1720846744
Name:ART THERAPY PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:ART THERAPY PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:G
Authorized Official - Last Name:STADLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:575-779-5719
Mailing Address - Street 1:2423 CLUB RD
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-1501
Mailing Address - Country:US
Mailing Address - Phone:575-779-5719
Mailing Address - Fax:
Practice Address - Street 1:190 CENTRAL PARK SQ STE 208
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-4005
Practice Address - Country:US
Practice Address - Phone:575-779-5719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-13
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health