Provider Demographics
NPI:1508159773
Name:KID'S THERAPLAY, INC
Entity Type:Organization
Organization Name:KID'S THERAPLAY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:STAR
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC/LPC
Authorized Official - Phone:301-202-7012
Mailing Address - Street 1:725 PARK STREET
Mailing Address - Street 2:SUITE 281
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502
Mailing Address - Country:US
Mailing Address - Phone:301-202-7012
Mailing Address - Fax:321-452-2802
Practice Address - Street 1:725 PARK STREET
Practice Address - Street 2:SUITE 281
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502
Practice Address - Country:US
Practice Address - Phone:301-202-7012
Practice Address - Fax:321-452-2802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-22
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7949101YM0800X, 252Y00000X
WVLPC2309101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811814100Medicaid