Provider Demographics
NPI:1043735012
Name:COME PLAY, STL LLC
Entity Type:Organization
Organization Name:COME PLAY, STL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:EVANGELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CAS, RPT
Authorized Official - Phone:314-312-2357
Mailing Address - Street 1:4002 BOTANICAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-3906
Mailing Address - Country:US
Mailing Address - Phone:708-805-4363
Mailing Address - Fax:
Practice Address - Street 1:3115 S GRAND BLVD STE 224
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-1047
Practice Address - Country:US
Practice Address - Phone:314-312-2357
Practice Address - Fax:844-789-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-10
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013041573101YP2500X
MO102L00000X
MO287066225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty