Provider Demographics
NPI:1487198404
Name:THERAPEUTIC PLAY AND COUNSELING
Entity Type:Organization
Organization Name:THERAPEUTIC PLAY AND COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:STOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMHP,LPC
Authorized Official - Phone:402-371-9606
Mailing Address - Street 1:1310 N 13TH ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-2592
Mailing Address - Country:US
Mailing Address - Phone:402-371-9606
Mailing Address - Fax:
Practice Address - Street 1:1310 N 13TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-2592
Practice Address - Country:US
Practice Address - Phone:402-371-9606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3613, 1809101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1002554100Medicaid