Organization
INDIGO ART THERAPY STUDIO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY ELIZABETH DESOUSA MS, ATR-BC (ART THERAPIST, CO-OWNER)
(904) 520-4191
Entity
Organization
Contact information
Practice address
1804 SAN MARCO PL, JACKSONVILLE, FL 32207-3247
(904) 520-4191
(904) 441-6901
Mailing address
1804 SAN MARCO PL, JACKSONVILLE, FL 32207-3247
(904) 520-4191
(904) 441-6901
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
221700000X
Art Therapist
Primary
—
—
Other
Enumeration date
10/04/2021
Last updated
10/04/2021
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