Provider Demographics
NPI:1568706125
Name:COUNSELING AND PLAY THERAPY CENTER
Entity Type:Organization
Organization Name:COUNSELING AND PLAY THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:MAUDE
Authorized Official - Last Name:HARRIET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-217-2161
Mailing Address - Street 1:427 N ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:WY
Mailing Address - Zip Code:82834-1712
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834-1846
Practice Address - Country:US
Practice Address - Phone:307-217-2161
Practice Address - Fax:307-684-9037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY807101YP2500X
WY1139101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1124268354OtherNPI
1740597913OtherNPI