Provider Demographics
NPI:1164109773
Name:PLAYFUL ON PURPOSE LLC
Entity Type:Organization
Organization Name:PLAYFUL ON PURPOSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-732-2829
Mailing Address - Street 1:1135 GRAND CENTRAL PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2797
Mailing Address - Country:US
Mailing Address - Phone:832-632-2177
Mailing Address - Fax:
Practice Address - Street 1:1135 GRAND CENTRAL PKWY STE 250
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2797
Practice Address - Country:US
Practice Address - Phone:832-632-2177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty