Provider Demographics
NPI:1760230619
Name:VIBRANCE ART THERAPY
Entity type:Organization
Organization Name:VIBRANCE ART THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KALLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PASCH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:313-744-2417
Mailing Address - Street 1:27733 JOHN R RD # 1062
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3368
Mailing Address - Country:US
Mailing Address - Phone:313-744-2417
Mailing Address - Fax:313-751-3695
Practice Address - Street 1:27733 JOHN R RD # 1062
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3368
Practice Address - Country:US
Practice Address - Phone:313-744-2417
Practice Address - Fax:313-751-3695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty