Provider Demographics
NPI:1487839767
Name:CENTER FOR FAMILY COUNSELING AND PLAY THERAPY
Entity Type:Organization
Organization Name:CENTER FOR FAMILY COUNSELING AND PLAY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:F
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LPC, RPT-S
Authorized Official - Phone:214-509-0500
Mailing Address - Street 1:8 PRESTIGE CIR
Mailing Address - Street 2:SUITE 122
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-3432
Mailing Address - Country:US
Mailing Address - Phone:214-509-0500
Mailing Address - Fax:214-509-0555
Practice Address - Street 1:8 PRESTIGE CIR
Practice Address - Street 2:SUITE 122
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3432
Practice Address - Country:US
Practice Address - Phone:214-509-0500
Practice Address - Fax:214-509-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9471101YP2500X
TX003368106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty