| Indigo Art Therapy Studio Llc | |
|
1804 San Marco Pl Jacksonville FL 32207-3247 | |
| (904) 520-4191 | |
| (904) 441-6901 |
| Full Name | Indigo Art Therapy Studio Llc |
|---|---|
| Speciality | Art Therapist |
| Location | 1804 San Marco Pl, Jacksonville, Florida |
| Authorized Official Name and Position | Kelly Elizabeth Desousa (ART THERAPIST, CO-OWNER) |
| Authorized Official Contact | 9045204191 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Indigo Art Therapy Studio Llc 1804 San Marco Pl Jacksonville FL 32207-3247 Ph: (904) 520-4191 | Indigo Art Therapy Studio Llc 1804 San Marco Pl Jacksonville FL 32207-3247 Ph: (904) 520-4191 |
| NPI Number | 1124790415 |
|---|---|
| Provider Enumeration Date | 10/04/2021 |
| Last Update Date | 10/04/2021 |
| Certification Date | 10/04/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124790415 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 221700000X | Art Therapist | (* (Not Available)) | Primary |
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