Provider Demographics
NPI:1255739850
Name:CREATIVE ARTS THERAPY STUDIO, LLC
Entity type:Organization
Organization Name:CREATIVE ARTS THERAPY STUDIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MUSIC THERAPIST / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IRVIN
Authorized Official - Middle Name:SAYOC
Authorized Official - Last Name:KALUGDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MT-BC, MMT
Authorized Official - Phone:202-627-0072
Mailing Address - Street 1:5459 MITTENDORFF LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-3906
Mailing Address - Country:US
Mailing Address - Phone:202-627-0072
Mailing Address - Fax:
Practice Address - Street 1:5459 MITTENDORFF LN
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-3906
Practice Address - Country:US
Practice Address - Phone:202-627-0072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Multi-Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance TherapistGroup - Multi-Specialty