Provider Demographics
NPI:1093483109
Name:WAYS OF PLAY COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:WAYS OF PLAY COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNER-HORON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, RPT, NCC
Authorized Official - Phone:636-344-0580
Mailing Address - Street 1:5377 STATE HWY N
Mailing Address - Street 2:SUITE 365
Mailing Address - City:COTTLEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63304
Mailing Address - Country:US
Mailing Address - Phone:636-344-0580
Mailing Address - Fax:
Practice Address - Street 1:5377 STATE HWY N
Practice Address - Street 2:SUITE 365
Practice Address - City:COTTLEVILLE
Practice Address - State:MO
Practice Address - Zip Code:63304
Practice Address - Country:US
Practice Address - Phone:636-344-0580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1215487590Medicaid