Provider Demographics
NPI:1043962111
Name:IGNITE ADVENTURES LLC
Entity type:Organization
Organization Name:IGNITE ADVENTURES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:512-607-7897
Mailing Address - Street 1:5617 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-1102
Mailing Address - Country:US
Mailing Address - Phone:512-607-7897
Mailing Address - Fax:
Practice Address - Street 1:1306 BARONETS TRL
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-6899
Practice Address - Country:US
Practice Address - Phone:512-607-7897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IGNITE ADVENTURES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty