Provider Demographics
NPI:1427419266
Name:PLAYFUL PATH COUNSELING, LLC
Entity Type:Organization
Organization Name:PLAYFUL PATH COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:479-274-8132
Mailing Address - Street 1:4943 OLD GREENWOOD RD STE 8
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-6923
Mailing Address - Country:US
Mailing Address - Phone:479-274-8132
Mailing Address - Fax:479-431-4430
Practice Address - Street 1:4943 OLD GREENWOOD RD STE 8
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6923
Practice Address - Country:US
Practice Address - Phone:479-274-8132
Practice Address - Fax:479-431-4430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0906036101YP2500X
AR869-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty