Provider Demographics
NPI:1417559998
Name:PLAYFUL JOURNEYS, INC
Entity Type:Organization
Organization Name:PLAYFUL JOURNEYS, INC
Other - Org Name:PLAYFUL JOURNEYS COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:907-376-9091
Mailing Address - Street 1:1150 S COLONY WAY STE 3
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6972
Mailing Address - Country:US
Mailing Address - Phone:907-376-9091
Mailing Address - Fax:
Practice Address - Street 1:634 S BAILEY ST STE 103
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6360
Practice Address - Country:US
Practice Address - Phone:907-376-9091
Practice Address - Fax:907-376-9094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-10
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1694035Medicaid