Indigo Art Therapy Studio LLC

Primary specialty

Art TherapistTaxonomy code 221700000X

Legal business name

INDIGO ART THERAPY STUDIO LLC

Practice address

1804 San Marco PL
Jacksonville, FL 32207-3247

Phone

(904) 520-4191

Fax

(904) 441-6901

NPI assigned

Oct 4, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kelly Elizabeth Desousa, MS, ATR-BCNPI 1124513106

Title

Art Therapist, Co-Owner

Phone

(904) 520-4191

Specialties & licenses 2

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kelly Elizabeth Desousa, MS, ATR

  • Art Therapist
  • Jacksonville, FL
  • NPI 1124513106
  NPD Authorized official
• Devon Schlegel, ATR-BC, LPC, LMHC

  • Art Therapist
  • Jacksonville, FL
  • NPI 1922540772

  Mental Health

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633305600000",
    "number": "1124790415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1804 SAN MARCO PL",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322073247",
            "telephone_number": "904-520-4191",
            "fax_number": "904-441-6901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1804 SAN MARCO PL",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322073247",
            "telephone_number": "904-520-4191",
            "fax_number": "904-441-6901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIGO ART THERAPY STUDIO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-04",
        "last_updated": "2021-10-04",
        "certification_date": "2021-10-04",
        "status": "A",
        "authorized_official_last_name": "DESOUSA",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "ART THERAPIST, CO-OWNER",
        "authorized_official_telephone_number": "904-520-4191",
        "authorized_official_credential": "MS, ATR-BC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "221700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Art Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jenna Marie Indingaro, CRNA
• Lori Indriolo, PHARMD
• Klaudia Ruby Inesta
• Ramses E Infante Palacios
• Augusto Infante, CRNA

• Art Therapist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Art Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.