Provider Demographics
NPI:1184515306
Name:CREATIVE SPARK ART THERAPY LLC
Entity type:Organization
Organization Name:CREATIVE SPARK ART THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:TERMINI
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, ATR
Authorized Official - Phone:321-327-3793
Mailing Address - Street 1:344 MEADOWWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-3824
Mailing Address - Country:US
Mailing Address - Phone:321-536-3195
Mailing Address - Fax:
Practice Address - Street 1:122 4TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-3112
Practice Address - Country:US
Practice Address - Phone:321-327-3793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)