Provider Demographics
NPI:1487007134
Name:YOUNG CHILDS PLAY THERAPY INC
Entity Type:Organization
Organization Name:YOUNG CHILDS PLAY THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TRODGLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-978-0254
Mailing Address - Street 1:3304 SEVEN PINES DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-6638
Mailing Address - Country:US
Mailing Address - Phone:618-978-0254
Mailing Address - Fax:618-235-1907
Practice Address - Street 1:3304 SEVEN PINES DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62221-6638
Practice Address - Country:US
Practice Address - Phone:618-978-0254
Practice Address - Fax:618-235-1907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty