Provider Demographics
NPI:1801586110
Name:PRISM ART THERAPY LLC
Entity type:Organization
Organization Name:PRISM ART THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:THILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPAT, LPC
Authorized Official - Phone:856-258-0818
Mailing Address - Street 1:63 E FLEMING PIKE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-2462
Mailing Address - Country:US
Mailing Address - Phone:215-990-4874
Mailing Address - Fax:
Practice Address - Street 1:146 S LAKEVIEW DR STE 300
Practice Address - Street 2:
Practice Address - City:GIBBSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08026-1018
Practice Address - Country:US
Practice Address - Phone:856-258-0818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty