Provider Demographics
NPI:1497219653
Name:INNOVATIVE FAMILY THERAPY & PLAY THERAPY CENTER LLC
Entity Type:Organization
Organization Name:INNOVATIVE FAMILY THERAPY & PLAY THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMFT
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:RECKLING
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT, RPT
Authorized Official - Phone:319-759-9414
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-0012
Mailing Address - Country:US
Mailing Address - Phone:319-759-9414
Mailing Address - Fax:
Practice Address - Street 1:409 N 4TH ST STE 108
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-5255
Practice Address - Country:US
Practice Address - Phone:319-759-9414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty