Provider Demographics
NPI:1841905767
Name:MICHELLE WATERS ART THERAPY
Entity type:Organization
Organization Name:MICHELLE WATERS ART THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ART THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, ATR
Authorized Official - Phone:423-902-8307
Mailing Address - Street 1:3851 1/2 N KEDVALE AVE APT C3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-3120
Mailing Address - Country:US
Mailing Address - Phone:423-902-8307
Mailing Address - Fax:
Practice Address - Street 1:800 DEVON AVE STE 10
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4760
Practice Address - Country:US
Practice Address - Phone:423-902-8307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty