Provider Demographics
NPI:1003563404
Name:CONNECT PLAY THERAPY & FAMILY THERAPY, INC.
Entity Type:Organization
Organization Name:CONNECT PLAY THERAPY & FAMILY THERAPY, INC.
Other - Org Name:CONNECTED LIFE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:HOUK CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:949-922-4564
Mailing Address - Street 1:18 TECHNOLOGY DR STE 118
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2310
Mailing Address - Country:US
Mailing Address - Phone:949-922-4564
Mailing Address - Fax:
Practice Address - Street 1:18 TECHNOLOGY DR STE 118
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2310
Practice Address - Country:US
Practice Address - Phone:949-922-4564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-04
Last Update Date:2023-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health