Provider Demographics
NPI:1396184883
Name:BATON ROUGE PLAY THERAPY, LLC
Entity Type:Organization
Organization Name:BATON ROUGE PLAY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:MARIE SWANSON
Authorized Official - Last Name:TAHERI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:225-308-1735
Mailing Address - Street 1:6810 JEFFERSON HWY APT 2204
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8178
Mailing Address - Country:US
Mailing Address - Phone:225-308-1735
Mailing Address - Fax:
Practice Address - Street 1:3535 S SHERWOOD FOREST BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2255
Practice Address - Country:US
Practice Address - Phone:225-308-1735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00912662261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center