Provider Demographics
NPI:1750894887
Name:HEARTEN STUDIO LLC
Entity type:Organization
Organization Name:HEARTEN STUDIO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:C
Authorized Official - Last Name:DAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-742-8927
Mailing Address - Street 1:117 ADAIR DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-1802
Mailing Address - Country:US
Mailing Address - Phone:865-742-8927
Mailing Address - Fax:
Practice Address - Street 1:117 ADAIR DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-1802
Practice Address - Country:US
Practice Address - Phone:865-742-8927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-11
Last Update Date:2017-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178010175101YM0800X
TNLPC0000003977101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty