Provider Demographics
NPI:1508753476
Name:HEROIC HEARTS PLAY THERAPY, LLC
Entity type:Organization
Organization Name:HEROIC HEARTS PLAY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:864-909-2680
Mailing Address - Street 1:56152 ORCHID RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46619-1121
Mailing Address - Country:US
Mailing Address - Phone:864-909-2680
Mailing Address - Fax:
Practice Address - Street 1:115 S MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-2051
Practice Address - Country:US
Practice Address - Phone:864-909-2680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)