Provider Demographics
NPI:1740899491
Name:TAKE ACTION ART THERAPY LLC
Entity type:Organization
Organization Name:TAKE ACTION ART THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GANNON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-575-8700
Mailing Address - Street 1:PO BOX 162
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06783-0162
Mailing Address - Country:US
Mailing Address - Phone:860-575-8700
Mailing Address - Fax:
Practice Address - Street 1:229 BACON POND RD APT 154
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-3692
Practice Address - Country:US
Practice Address - Phone:860-575-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty