Provider Demographics
NPI:1447603782
Name:PLAYFUL HEALING & COUNSELING
Entity Type:Organization
Organization Name:PLAYFUL HEALING & COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:EGG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:812-449-7367
Mailing Address - Street 1:408 S CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-9702
Mailing Address - Country:US
Mailing Address - Phone:812-449-7367
Mailing Address - Fax:
Practice Address - Street 1:408 S CARROLL ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-9702
Practice Address - Country:US
Practice Address - Phone:812-449-7367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006712A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health