Provider Demographics
NPI:1073952271
Name:GROUND WORK PLAY THERAPY, INC.
Entity Type:Organization
Organization Name:GROUND WORK PLAY THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KIRTLAND-SCHWEYER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S, RPT-S
Authorized Official - Phone:419-289-4825
Mailing Address - Street 1:304 COUNTY ROAD 2000
Mailing Address - Street 2:
Mailing Address - City:JEROMESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44840-9758
Mailing Address - Country:US
Mailing Address - Phone:419-289-4825
Mailing Address - Fax:419-289-4826
Practice Address - Street 1:304 COUNTY ROAD 2000
Practice Address - Street 2:
Practice Address - City:JEROMESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44840-9758
Practice Address - Country:US
Practice Address - Phone:419-289-4825
Practice Address - Fax:419-289-4826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0501218251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0090942Medicaid